Predicting Quality of Life After Radical Prostatectomy
Results from CaPSURE
Published in: The Journal of Urology, v. 171, no. 2, pt. 1, Feb. 2004, p. 703-708
Posted on RAND.org on January 01, 2004
PURPOSE: The authors investigated the usefulness of patient and tumor characteristics in predicting continence, potency, and physical and mental health 1 year after radical prostatectomy. MATERIALS AND METHODS: They studied 372 men drawn from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national, longitudinal cohort, who underwent radical prostatectomy alone for localized prostate cancer. Health related quality of life (HRQOL) was assessed before and 12 months after (range 9 to 15) surgery with the Physical and Mental Component Summaries of the RAND 36-Item Health Survey and the Sexual and Urinary Function scales of the UCLA Prostate Cancer Index. Covariates included clinical T stage, prostate specific antigen Gleason sum, age, race, income, education, relationship status, comorbidity and overall health self-rating. Chi-square and backward stepwise multivariate analysis identified differences between men who did and did not return to baseline HRQOL postoperatively. Return to baseline HRQOL score was set at 90% or greater for physical and mental health, 80% for continence and 75% for potency. RESULTS: After 1 year 63%, 20%, 80% and 86% returned to baseline continence, potency, physical health and mental health, respectively. Men younger than 65 years were more likely to return to baseline continence, potency, and physical but not mental health. Univariate analyses also revealed several other characteristics to predict (p <0.05) better outcomes including household income greater than 30,000 US dollars (potency, physical health), fewer comorbidities (potency, physical health), and excellent or very good health self-rating (mental health). In multivariate analyses subjects younger than 65 years were more likely to return to baseline urinary (OR 1.8, p <0.01), sexual (OR 2.5, p <0.01) and physical health (OR 1.8, p = 0.03). Furthermore, subjects with no comorbidities were more likely to return to baseline physical health (OR 2.5, p = 0.01), while those with an excellent or very good baseline health self-rating were more likely to return to baseline mental health (OR 2.3, p = 0.01). Clinical T stage, prostate specific antigen and Gleason sum did not predict return to baseline HRQOL. CONCLUSIONS: Younger patient age (less than 65) is associated with a greater likelihood of returning to baseline continence, potency and physical health after radical prostatectomy. In addition, patients who underwent radical prostatectomy without comorbidities and those with high health self-ratings are more likely to return to baseline physical and mental health, respectively. Preoperative tumor characteristics do not appear to be associated with regaining baseline HRQOL, suggesting that factors not measured in this model may be important in optimizing quality of life after radical prostatectomy.