Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: A Systematic Review of the Literature
Creators: name: Wobker, Sara E.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2008

description: Background: Prostate cancer is the most commonly diagnosed non-cutaneous cancer in American men. In 2007, approximately 218,890 men were diagnosed with and 27,050 men died from prostate cancer. With the advent of PSA screening, younger men are being diagnosed with prostate cancer at the earliest stages of disease. Over 90% of cancers are detected at the localized or regional stage, and early detection allows for a number of treatment options. Currently, there is no consensus on the best treatment for localized prostate cancer, but the most commonly utilized options are prostatectomy, radiation therapy and active surveillance. Without evidence from randomized controlled trials on the mortality benefits of these treatments, health-related quality of life (HRQOL) is becoming an increasingly important factor in treatment decision-making. The purpose of this paper is to systematically review the evidence regarding HRQOL after primary treatment for localized prostate cancer. Methods: Inclusion criteria were English language articles published between 1995 and 2007. The studies must have focused on primary treatment of localized prostate cancer. Any study that addressed metastatic cancer or secondary treatment was excluded. Studies must use the SF-36 questionnaire for measuring general HRQOL. All study types were included in the review. The literature search was conducted using the PubMed MeSH terms Prostatic Neoplasms/therapy [MeSH] and keywords localized or early stage AND (SF-36 OR short form 36). An abstract review was then performed, followed by a full article review. At the end of the selection process, 14 articles met all the inclusion criteria and were considered in this review. Results The 14 studies varied widely in their study designs. The reporting of HRQOL within each study differed between studies, with some reporting only component scores, while others report each of the eight domains of the SF-36. Considering these differences, the review showed that there were some unique trends for recovery of HRQOL by treatment type. For those men undergoing prostatectomy, early decreases in specific domains of HRQOL (bodily pain, role physical, and role emotional) were seen at 3 to 6 months. These deficits usually returned to the patients' baseline by 12 months after treatment. For men choosing radiation, fewer decreases were seen in the immediate post-treatment period. Long term decreases in role physical and role emotional were seen in those studies with follow-up periods longer than 1 to 2 years. The data regarding active surveillance was relatively sparse, with only three studies evaluating HRQOL for those men choosing active surveillance. There was some evidence for decreases in physical function, general health and role emotional. Conclusions: Without convincing randomized controlled evidence showing a mortality benefit for any of the primary treatment options, HRQOL serves as a useful outcome for treatment decision-making. More studies, including upcoming randomized controlled trials, should include robust measures of HRQOL as primary outcomes in their study designs.