Open Access

ARTICLE

A prospective study of health-related quality of life outcomes among men treated for intermediate- and high-risk prostate cancer: the impact of primary and secondary therapies

Mazen Alsinnawi¹, Jennifer Cullen^2,3,4, Lauren M. Hurwitz^2,3, Katherine E. Levie^2,3, John F. Burns¹, Inger L. Rosner^2,5, Timothy C. Brand^2,6, Sean Stroup^2,7, Joseph R. Sterbis^2,8, Kevin Rice^2,5, Galen Conti^2,3, Christopher R. Porter^1,2

1 Virginia Mason Medical Center, Seattle, Washington, USA
2 Department of Surgery, Center for Prostate Disease Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
3 Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
4 Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
5 Walter Reed National Military Medical Center, Bethesda, Maryland, USA
6 Madigan Army Medical Center, Tacoma, Washington, USA
7 Naval Medical Center San Diego, San Diego, California, USA
8 Tripler Army Medical Center, Honolulu, Hawaii, USA
Address correspondence to Dr. Jennifer Cullen, The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 300, Bethesda, MD 20817 USA

Canadian Journal of Urology 2019, 26(4), 9809-9820.

Abstract

Introduction: To assess the impact of primary and secondary therapies for high- and intermediate-risk prostate cancer on health-related quality of life (HRQoL).
Materials and methods: A prospective study was initiated in 2007 at Center for Prostate Disease Research Multicenter National Database sites. Longitudinal patterns in HRQoL from baseline (pre-treatment) to 5 years post-diagnosis were examined for patients with high- and intermediate-risk prostate cancer, treated by radical prostatectomy (RP) or external beam radiation therapy (EBRT). Change in HRQoL was modeled using linear regression models fit with generalized estimating equations. The probability of maintaining HRQoL was compared between patients receiving RP only versus RP with secondary treatment.
Results: Of 445 men with high- and intermediate-risk prostate cancer, 228 underwent RP and 143 had EBRT±androgen deprivation therapy (ADT). Fifty received secondary therapy (EBRT and/or ADT or chemotherapy) after RP. RP patients showed a greater decline over time in sexual function and bother and urinary function compared to EBRT±ADT patients. Patients who had secondary therapy after RP were less likely to maintain their HRQoL compared to those who had RP alone. These differences were most pronounced for sexual and hormonal function.
Conclusions: Prostate cancer patients experience significant declines in HRQoL after primary therapy. Additional secondary therapy after RP, in the form of EBRT and/or ADT, appears to be responsible for further deterioration in HRQoL outcomes.

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