ASCO GU 2018: Life After Prostate Cancer Diagnosis: One Step Beyond

San Francisco, CA (UroToday.com) In the current era of prostate cancer management, we sometimes forget to look at the bigger picture. In this cross-sectional study, the authors evaluate the whole PCa population compared to the general population. While other studies often focus on very specific subsets of PCa patients, this data can help provide a broader, albeit less specific, picture of how PCa patients are doing compared to the general population.

This was a postal survey of all men diagnosed with PCa in the United Kingdom in the prior 18-42 months (1.5-3.5 years). They were compared to men never diagnosed in Ireland (General Population, GenPop). The outcomes were generic health-related quality of life [HRQL] (using the EQ-5D questionnaire) and PCa specific outcomes (EPIC-26 & interventions for erectile dysfunction). Obviously, due to the broadness of the study, the results are generalizable, but granularity is limited.

35,823 PCa survivors responded, which represents a 60.8% response rate. In contrast, 2,995 men from the GenPop response (30% response rate). Median age of the PCa patients was 71. Median age of the GenPop was younger. Patient were primarily white in both groups (>90%). Of me with PCa, 55% had stage 1/2 disease, 20% with stage 3 disease, and 11% with stage 4 disease. Treatment for PCa varied – 20% surgery alone, 28% EBRT +/- ADT, 8% active surveillance, and the remainder a mix of watchful waiting, systemic therapy, brachytherapy.

Overall HRQL using the EQ-5D questionnaire was slightly lower in the PCa men than the GenPop; this difference was significant only in stage 4 disease. Lower stage PCa did not yield worse HRQOL.

Men with PCa were less likely to report problems in individual EQ5D domains than men in the GenPop (62.0% vs. 68.8%). While both populations were most likely to report pain/discomfort, this was lower in PCa men than the GenPop (42.1% vs. 60.8%). As can be expected, problems increased with age in all domains.

On the EPIC-26, men generally reported good function; however PCa survivors reported poorer sexual function (78.9% vs 48%) than GenPop, except in the oldest subset. With regards to erectile function, medications/devices/services to aid or improve erections were offered to 45.4%, 26.0% & 16.9% respectively in the PCa group (and considered helpful by 14.7%, 7.5% & 3.2%). Men with PCa reported more problems with urinary leakage (13.1% vs. 7.1%), particularly after surgery. Hormonal symptoms were linked with receiving Androgen Deprivation Therapy and, to a lesser extent, external beam radiation (likely due to concurrent ADT).

While the results of the study confirm that PCa patients have greater urinary and sexual function complaints than the general population, it is unclear that this study provides any novel results. It does reassure us that, on the larger scale, PCa patients do not do worse than the general population.

Limitations / Discussion Points:
1. Postal survey with inherent limitations – the response rate was much higher in the PCa population than in the GenPop, which may introduce some bias into the results.
2. The two populations are different at-risk groups – the Irish population (GenPop) vs. UK population (PCa).

Speaker: Adam Glaser

Co-Authors: Amy Downing, Penny Wright, Luke Hounsome, Paul Kind, Peter John Selby, Sarah Wilding, David Donnelly, Hugh Butcher, Eila Watson, Wagland Richard, James Catto, William Cross, Malcolm David Mason, Linda Sharp, Galina Velikova, Rebecca Mottram, Majorie Allen, Therese Kearney, Gavin Anna

Institution(s): University of Leeds, Leeds, United Kingdom; Public Health England, Bristol, United Kingdom; Cancer Research Building, Leeds, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Oxford Brookes University, Oxford, United Kingdom; Southampton University, Southampton, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Cardiff University, Cardiff, United Kingdom; Newcastle University, Newcastle, United Kingdom; Leeds Institute of Cancer and Pathology/ St James's Institute of Oncology, Leeds, United Kingdom; Queen's University, Belfast, United Kingdom

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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