A national study of adverse effects and global quality of life among candidates for curative treatment for prostate cancer
Authors: Kyrdalen Anne E. , Dahl Alv A. , Hernes Eivor , Småstuen Milada Cvancarova , Fosså Sophie D. 
Published: June 2012

What's known on the subject? and What does the study add?

Studies comparing adverse effects after different treatment methods are few and lack information on additional treatment and cancer relapse. Some US studies have provided population‐based estimates on adverse effects, however, figures from Europe are most often based on mono‐institutional experience or multicentre studies from high‐volume university‐affiliated hospitals with selected patient populations. Few studies have investigated the relationship between presence of urinary, bowel or sexual dysfunction and global quality of life (QoL).

This population‐based study investigated real‐life practice with regard to prostate cancer in men who were potential candidates for curative treatment, based on high‐quality national registry data. Treatment groups of recurrence‐free men who completed their treatment or who received no cancer treatment were measured as to adverse effects, global QoL and the association between them. The study shows that each treatment method is associated with distinct patterns of urinary, bowel and sexual dysfunction and that irritative–obstructive urinary symptoms are associated with increased risk of low global QoL. This large survey also investigates the use of medication for erectile dysfunction and the relationship between such use and global QoL.

Objectives

To provide population‐based estimates of typical adverse effects (AEs), e.g. urinary, bowel and sexual dysfunction, in patients with non‐metastatic recurrence‐free prostate cancer (PCa) by curative treatment method, including no treatment.

To describe associations between typical AEs and global quality of life (QoL) and to study patients' use of medication for erectile dysfunction (EDmed) and the relationship between such use and global QoL.

Patients and Methods

In October 2006 a national population‐based sample of PCa survivors diagnosed in 2004 was invited to a postal survey focusing on treatment‐related AEs and global QoL, 12–32 months after treatment start. All had completed their initial treatment.

In the present study, 771 compliers were categorized into four groups of localized or locally advanced PCa related to the treatment they completed: (i) no treatment; (ii) radical prostatectomy (RP); (iii) radiotherapy (RAD) without hormones; and (iv) RAD with hormone therapy of 3–24 months duration.

Measurement of AEs was restricted to function, using selected items from the 50‐item Expanded Prostate Cancer Index Composite and the Brief Sexual Function Inventory among others, whereas global QoL was measured with the 12‐item short‐form health survey.

National prescription data enabled assessment of adjuvant hormone application and EDmed use.

Results

Men who had undergone RP reported more urinary incontinence (24%) than the other treatment groups, but had the lowest level of moderate/severe urinary irritative–obstructive symptoms. Men from the ‘no treatment’ group had the highest level of moderate/severe irritative–obstructive urinary symptoms. Men who had undergone RAD reported higher levels of irritative intestinal symptoms and faecal leakage compared with the RP group and the no treatment group.

In all treatment groups, poor sexual drive and poor erectile function were common AEs, with men treated with RP reporting the highest prevalence of poor erectile function (89%).

Presence of irritative–obstructive urinary symptoms and poor sexual drive were independently associated with low global QoL in multivariate analyses.

Fifty percent of the study group had used EDmed after treatment start, but only 47% of them were still using EDmed at the time of the survey. Use of EDmed was not significantly associated with global QoL.

Conclusions

PCa survivors after curative treatment, but also patients without any anticancer therapy, report high levels of urinary and sexual AEs.

Irritative–obstructive urinary symptoms and poor sexual drive were significantly associated with low global QoL, whereas erectile function and use of EDmed were not.