Effect of treatment on quality of life among men with clinically localized prostate cancer

BACKGROUND. Quality-of-life outcomes are an important consideration for patients evaluating therapeutic options for localized prostate cancer. OBJECTIVES. The objective of this study was to describe the effect of treatment choice on change in health-related quality of life (HRQOL) among men with clinically localized prostate cancer. RESEARCH DESIGN. This was a prospective observational study. SUBJECTS. The study subjects were 122 men with clinically localized adenocarcinoma of the prostate. Forty-two subjects (34%) underwent radical prostatectomy, 51 (42%) underwent radiation therapy, and 29 (24%) were followed with expectant management. MEASURES. The University of California at Los Angeles Prostate Cancer Quality of Life Index and the Medical Outcomes Study Short Form-36 were administered before and 3 and 12 months after initial treatment. The study used an analysis of covariance model adjusted for baseline differences in clinical and demographic factors. RESULTS. Men who underwent radical. prostatectomy experienced significant declines in urinary and sexual function and bother that persisted at 12 months after treatment. Men treated with radiation therapy experienced smaller but significant declines in sexual function and a decline in social function. Expectant management patients did not have a significant change in disease-targeted or generic HRQOL domains. Differential rates of change in urinary and sexual function between treatment groups persisted after adjustment for differences in pretreatment clinical and demographic factors. CONCLUSIONS. Men undergoing radical prostatectomy have substantial declines in urinary and sexual function, and men undergoing radiotherapy have declines in sexual function. Men undergoing expectant management have no change in disease-specific or general HRQOL in the first year after treatment.