BMJ: Patients with localized prostate cancer who received active treatment early had a worse quality of life for 15 years.

Prostate cancer is the second most common cancer in men and fourth among all cancer types.
2018, 1.3 million men worldwide were diagnosed with prostate cancer.
in high-income countries, most prostate cancers are limited in the early stages of diagnosis (clinical phases from T1a to T2c, with no evidence of lymph node aggression or distant metastasis).
compared with the general population, the five-year relative survival rate of limited prostate cancer is close to 100 per cent, and the survival rate for each stage in 10 and 15 years is 98 per cent and 96 per cent, respectively.
, it is increasingly important to consider the impact of different treatment options on quality of life in treatment decisions.
in the current study, short-term quality of life results have been widely assessed, with only a few reports assessing long-term (10 years or more) quality of life and survival rates associated with different treatment options.
recently, a new study published in BMJ called Fifteen year quality of life outcomes in men with with localized prostate cancer: population based Australian prospective study assessed changes in the quality of life associated with treatment in patients within 15 years of diagnosis of local prostate cancer.
study randomly recruited 1,642 prostate cancer patients under the age of 70 and 786 control groups from the NSW electorate to enter the NSW Prostate Cancer Treatment and Outcomes Study (PCOS).
of the study was to describe the association, differences and comparisons between long-term self-reported quality of life in male patients and common local prostate cancer treatments.
2. Determine whether previously self-reported changes in urination incontinence, smoothness, detofying function and overall health persisted and severity over a 15-year period during follow-up over a period of 3 and 10 years.
PCOS is a longitudinal queue study conducted in New South Wales, Australia's most populous state.
Baseline participants with sufficient clinical records (n-1874) completed follow-up surveys 1, 2, 3, 5, 10 and 15 years after diagnosis, if possible, and 1,642 of them had localized prostate cancer.
baseline, 786 men were randomly selected from the NSW electorate as control participants and matched their age and place of residence postcodes to patients on a 1:4 scale.
total, 495 (63.0 per cent) agreed and completed baseline surveys against 786 eligible men.
the control groups completed questionnaires 1, 2, 5 and 15 years after recruitment.
, the study included 1,642 men diagnosed with localized prostate cancer and 495 control groups.
Table 1. The results of the prostate cancer treatment and results study questionnaire in the treatment and control groups showed that 502 (30.6 per cent) of the 1,642 patients completed the baseline questionnaire and 103 (20.8 per cent) of the 495 population-based control groups completed the questionnaire over a 15-year follow-up period (table 1).
15-year-old participants ranged in age from 50 to 85 years (average 75.9 years).
15 years follow-up time for respondents was 15.2 years.
of the 502 participants, 333 (66%) initially received a cured prostatectomy, of which 192 (58%) had NSRP and 141 (42%) had non-NSRP.
In addition, 43 out of 502 patients (9 per cent) received external exposure or high dose rate proximity radiotherapy, 45 (9 per cent) received androgen deprivation treatment, 25 (5 per cent) received low dose rate proximity radiotherapy and 53 (11 per cent) received active surveillance/observation waiting.
erectile dysfunction is common in all treatment groups (62.3% (active monitoring/observation waiting, n=33/53) to 83.0% (non-NSRP, n=117/141);
without considering the retention of neurotechnology, patients who initially had a cure-all prostatectomy had the worst sex life outcomes and were the most severe early in follow-up, as also found in other studies.
the group receiving low-dose radiotherapy, most treatment groups improved sexual function during 15 years of follow-up.
men who received external exposure/high dose rate brachytherapy or androgen deprivation therapy reported more intestinal problems and persisted in the group receiving androgen deprivation therapy.
or not, self-described urinary incontinence is particularly common and persistent in men undergoing a cured prostatectomy, regardless of the use of neuroreserved technology.
incontinence also increased in the 15-year group receiving radiation therapy/high dose rate brachytherapy and androgen deprivation therapy.
Table 2. Prevalence of patients with limited prostate cancer and prevalence of patients in the control group who reported urinary incontinence, detocation problems or impotence 15 years after initial treatment showed a downward trend in physical and mental health in all groups between 10 and 15 years after diagnosis.
in the active monitoring/observation waiting group, the most severe late adverse reactions were associated with physical health, while in the androgen deprivation treatment group, mental health was associated.
, patients with localized prostate cancer who received initial active treatment typically had a worse long-term self-reported quality of life than men who were not diagnosed with prostate cancer.
men who undergo a cured prostatectomy are particularly less effective, especially in long-term sexual activity.
paper adds limited evidence and understanding of the long-term quality of life of patients with limited prostate cancer.
treatment had some adverse effects on quality of life compared to the age-matching control group.
most obvious and persistent adverse association is a decrease in sexual function, although the effect on men is limited.
, although the incidence of urinary incontinence is low, it is a bigger cause of trouble.
further research is needed to explore adjustments to personal experiences and long-term changes to determine where support and information gaps are and what measures may be taken to fill them.
clinicians and patients should be fully aware of these long-term quality-of-life outcomes and the possible long-term consequences of treatments when making treatment decisions.
: Carolyn G Mazariego, et al. Fifteen year quality of life outcomes in men with localized prostate cancer: population base Australian prospective study. BMJ 2020;371:m3503.liangying Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that state "Source: Mets Medicine" or "Source: MedSci Originals" are owned by Metz Medicine and are not authorized to be reproduced by any media, website or individual, and are authorized to be reproduced with the words "Source: Mets Medicine".
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