Purpose: This study compares the side effects of active surveillance, prostatectomy, radiation with or without adjuvant endocrine therapy, watchful waiting, and palliative therapy on patient-reported outcomes in a nationwide, population-based cohort of Danish men with prostate cancer.
Methods: A total of 15,465 participants completed questionnaires over a 5 year period (2011-2016). Condition-specific quality of life, focusing on urinary function, bowel incontinence, sexual function, and hormonal symptoms were investigated using the validated EPIC-26 questionnaire at diagnosis, 1 year- and 3- year follow-up. Patients were identified from the Danish Prostate Cancer Registry with data-linked to several national healthcare registries. Longitudinal analysis with linear mixed effects models were fitted to compare changes over time on quality of life symptom scores for five treatment modalities, adjusting for age, clinical TNM stage, PSA value, Gleason score, Charlson Comorbidity score, education, disposable income, and urbanization measured at time of prostate cancer diagnosis.
Results: There was a more than10-point decrease in mean scores across all symptom domains at 1-year follow-up. Thereafter mean scores for all symptom domains improved marginally and remained relatively unchanged at 3-year follow-up. Prostatectomy had the greatest negative effect on sexual function and urinary incontinence. Overall quality of life was most adversely affected by sexual function, regardless of treatment modality.
Conclusion: Clinical interventions for improving symptoms should focus particularly on the first year after prostate cancer diagnosis. Greater emphasis on improving sexual function should be practiced in clinical and rehabilitative care, since this area has the single greatest impact on symptom-specific QoL after primary treatment for prostate cancer.
Keywords: Patient-reported outcomes; Prostate cancer; Quality of life.
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