Prostate cancer active surveillance and health‐related quality of life: results of the Finnish arm of the prospective trial
Authors: Vasarainen Hanna , Lokman Utku , Ruutu Mirja , Taari Kimmo , Rannikko Antti 
Published: November 2011

Study Type – Therapy (case series)

Level of Evidence 4

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

Active surveillance is a management option in patients with localized prostate cancer. One concern is the possible psychological burden and quality‐of‐life effects caused by consciousness of living with untreated cancer. Previous studies have reported controversial results about the impact of active surveillance on patient's health‐related quality of life.

The data of the present study support the idea that patients with low‐risk prostate cancer manage well on active surveillance and do not develop short‐term mental or physical quality‐of‐life sequelae.

OBJECTIVE

To analyse longitudinal changes in general, mental and physical health‐related quality of life (HRQL) and urinary and erectile function in patients with low‐risk prostate cancer (PC) on active surveillance (AS).

PATIENTS AND METHODS

Patients comprised those (n= 124) enrolled in the Finnish arm of the Prostate Cancer Research International: Active Surveillance (PRIAS) study who were followed for at least 1 year (n= 80).

All patients with PC received validated questionnaires at the start of surveillance and after 1 year of follow‐up. General HRQL was assessed with the RAND 36‐Item Health Survey (RAND‐36), erectile function with the International Index of Erectile Function‐5 (IIEF‐5), and urinary symptoms with the International Prostate Symptom Score (IPSS) questionnaires.

Results were also compared with an age‐stratified general Finnish male population. A paired t‐test served to compare results over time and a non‐paired t‐test or a corresponding non‐parametric test, when applicable, served to compare the study group with the general population.

Pearson and Spearman correlations were analysed between possible HRQL‐affecting factors (demographic and clinical data) and HRQL data, followed by linear regression analysis to further evaluate any possible associations.

RESULTS

Of the 124 patients, 105 (85%) returned the baseline RAND‐36 questionnaire, and 75 (94%) of the 80 patients answered both the baseline and follow‐up questionnaires; 15 patients (12%) had discontinued AS, all for protocol‐based reasons, none due to anxiety or distress.

No differences existed in the HRQL main categories at the 1‐year follow‐up (mental and physical: P= 0.142 and P= 0.154, respectively). When all the eight dimensions were analysed separately, the physical role showed statistically significant improvement from a mean of 81 to a mean of 89 (P= 0.010).

No clinically significant correlations appeared between HRQL and age, diagnostic prostate‐specific antigen (PSA), free PSA or PSA change during follow‐up at any of the time points; in regression analysis, HRQL was not predictable by any of the variables available at diagnosis or during follow‐up.

No statistically significant changes occurred in urinary function as analysed by the IPSS (P= 0.121) or in erectile function by the IIEF‐5 questionnaire (P= 0.583).

Compared with an age‐stratified Finnish general male population, patients with PC on AS had a significantly better general mental and physical HRQL at diagnosis and after 1 year of follow‐up (P < 0.05).

CONCLUSIONS

Active surveillance does not provoke short‐term quality‐of‐life disturbances as assessed by standardized RAND‐36, IIEF‐5 and IPSS questionnaires.

None of the patients changed treatment due to anxiety.

Unexpectedly, PC patients on AS had significantly better general mental and physical HRQL than did a general age‐stratified Finnish male population.