Quality of Life in Men with Locally Advanced Adenocarcinoma of the Prostate

PURPOSE: The authors present longitudinal quality of life outcomes in a national observational cohort of men with locally advanced prostate adenocarcinoma. MATERIALS AND METHODS: The CaPSURE registry was used to evaluate quality of life in men with clinical T3 or T4 prostate adenocarcinoma who underwent primary treatment and had a minimum followup of 2 years. Records were reviewed for treatment, patient age, T stage, prostate specific antigen at diagnosis, body mass index, and initial and posttreatment quality of life using the SF-36 and UCLA-PCI questionnaires, which can each be scored from 0 to 100 with higher scores indicating better outcomes. The association of treatment type and quality of life changes after treatment were evaluated with multivariate mixed model analysis, adjusting for age, time of quality of life assessment, and interaction between treatment and time. RESULTS:Of the 13,740 men enrolled in CaPSURE 608 (4.42%) presented with T3 or T4 tumors. In this subgroup 151 men completed baseline and a minimum of 2 years of followup with quality of life data available. These men underwent primary treatment with radical prostatectomy (21%), cryotherapy (8%), brachytherapy (17%) or hormonal ablation (54%). The treatment cohort demonstrated significant decreases in quality of life, most profoundly in urinary and sexual function. Mean urinary function was 91 at baseline, which decreased to 82, 83 and 82 at 1, 2 and 3 years after treatment, respectively (p = 0.04). Mean sexual function was 38 at baseline, which decreased to 15, 16 and 14 at 1, 2 and 3 years after treatment, respectively (p <0.01). On multivariate analysis quality of life varied significantly by treatment type (p <0.01). CONCLUSIONS: Treatment for locally advanced prostate adenocarcinoma is associated with a significant burden in patients, notably decrements in urinary and sexual function. Clinicians should consider the impact that treatment imparts on quality of life when counseling patients with locally advanced disease.