Elsevier

Urology

Volume 54, Issue 3, September 1999, Pages 509-516
Urology

Adult Urology
Comparative quality-of-life analysis after radical prostatectomy or external beam radiation for localized prostate cancer

https://doi.org/10.1016/S0090-4295(99)00163-6Get rights and content

Abstract

Objectives. To determine and compare quality-of-life (QOL) evaluations from patients who received external beam radiation therapy or radical prostatectomy for the treatment of localized prostate cancer, and to compare differences in QOL assessments for urinary and sexual function after radical prostatectomy as reported by patient and physician.

Methods. Two hundred three patients treated by radical prostatectomy and 257 patients treated by external beam irradiation, all beyond 12-month follow-up after therapy, responded to a QOL questionnaire. The difference in responses with regard to bladder, bowel, and sexual function, overall satisfaction with treatment, and choice of the same treatment were assessed. Satisfaction with and choice of the same treatment were also specifically assessed according to bowel and bladder function and current disease status. The medical records of patients treated by radical prostatectomy were reviewed by an independent data manager to record the physician’s assessment of continence and sexual function for comparison with that patient’s assessment as noted in the questionnaire.

Results. Problems with urinary continence were more frequent among patients treated by radical prostatectomy; problems with gastrointestinal function were more frequent after irradiation. Sexual dysfunction was similar in both groups, although surgical patients experienced a greater impact on sexual relationships. The physician estimates of urinary continence were more favorable than the patient-reported outcomes. However, the physician estimate of sexual function closely approximated that of the patient. Preservation of sexual function among patients who underwent nerve-sparing surgery was disappointingly low. Only for the response to the question dealing with difficulty in achieving an erection was there a statistically significant benefit for patients receiving nerve-sparing versus non-nerve-sparing procedures. Patient satisfaction with and choice of the same treatment varied according to function and current disease status. Patients who had incontinence or bowel dysfunction or had evidence of recurrent disease were statistically less likely to choose the same treatment again when compared with functional and disease-free counterparts. Because irradiated patients were on average 6 years older than surgical patients, responses were adjusted for age; adjustment for age did not alter results.

Conclusions. QOL is determined by the treatment received, by the assessment source, and by the patient’s function and disease status at the time of assessment. Prospective and longitudinal studies will more accurately quantify immediate and chronic alterations in QOL. Uniformity of evaluation through consolidation of QOL instruments will permit more accurate cross-series and cross-treatment comparisons.

Section snippets

Material and methods

A computer data base of all patients treated for localized prostate cancer at our institution provided information about patients treated with radical prostatectomy between 1984 and 1994 or treated with irradiation between 1974 and 1994. Patients who were alive and more than 12 months past treatment were sent a questionnaire similar to that used by Fowler et al.3 (see Appendix for questions analyzed in this report). This same questionnaire was sent again to all patients 6 months later to

Results

Six hundred fourteen patients treated for localized prostate cancer who were alive at last contact were sent questionnaires; 137 were not evaluable because of intervening death, change of address and lost to follow-up, or confirmation that primary treatment had been administered elsewhere. Of the remaining 477 patients, a response by questionnaire or telephone was elicited from 460 patients (96.4%).

Surgical patients ranged in age from 43.5 to 73.7 years (mean 62.8, median 63.7). Irradiated

Comment

Assessing morbidity and the impact on QOL after surgery or radiation for localized prostate cancer has become an important focus of investigation. Physicians have traditionally relied on their perception of risks and benefits to direct treatment recommendations. Evidence exists that physicians in general are not skilled or accurate in their assessment of patient QOL.9, 10

Physician-directed studies have reported continence rates, defined as no pads and no stress urinary incontinence, of between

Acknowledgements

To Dianne Rowe and Lana Wilson for data management and Lynn Vass for manuscript preparation.

Cited by (142)

  • Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really?

    2017, Sexual Medicine Reviews
    Citation Excerpt :

    Self-reporting by patients who underwent an RRP at least 6 months previously showed an incidence of any degree of PPI at 65%, of which half required pads, diapers, or clamps.44 Efforts to address the discrepancy between patient- and physician-reported outcomes have come in the form of prospective studies40 and HRQoL reporting to a third party with tools such as the UCLA-PCI.72 In 1998, findings of the Prostate Cancer Strategic Urological Research Endeavor (CaPSURE) database, a national prospective cohort including patients with all stages of disease and different treatments, compared physician assessment and patient self-assessment across multiple HRQoL domains, including sexual and urinary function.

  • Quality of sexual life after radical prostatectomy

    2014, Revista Mexicana de Urologia
View all citing articles on Scopus
View full text