AUA 2018: Quality of Life After Surgery for Localized Prostate Cancer

San Francisco, CA ( Both overall and cancer specific survival rates are very high for patients diagnosed and treated for clinically localized prostate cancer. Thus, complications, functional outcomes and health-related quality of life are important for patients and physicians making and guiding treatment choices in this scenario. In a moderated poster presented at the American Urologic Association Annual Meeting, Dr. McClain and colleagues report on the association between treatment modality and quality of life among a cohort of patients treated with robotic assisted laparoscopic radical prostatectomy, brachytherapy, and cryotherapy at a single institution. 

The authors identified 373 patients who underwent one of the three relevant treatments and completed quality of life assessments using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. They assessed patient-reported urinary incontinence, urinary obstruction/irritative symptoms, bowel symptoms, sexual symptoms and hormonal symptoms) starting prior to treatment and continuing for up to 60 months after treatment. 

With a median follow-up of 41 months, the authors found that all prostate cancer treatments affected all quality of life domains, however, with unique profiles for each treatment. Robotic assisted radical prostatectomy and brachytherapy were both associated with significant declines in urinary continence. In contrast, patients who received cryotherapy had a return to baseline continence by 6 months and had significantly better continence-related quality of life than those who received brachytherapy. With respect to urinary obstruction/irritative symptoms, these were worst for patients who underwent brachytherapy, particularly when compared to patients who underwent radical prostatectomy. Similarly, bowel function was significantly worse for patients who underwent brachytherapy. All three groups had significant declines in sexual function, although this was most pronounced in the cryotherapy group and least pronounced in the brachytherapy group. Minimal effect on hormonal function was noted. 

Drawing upon a single institutional cohort, the authors describe the effect of common treatment for localized prostate cancer on health-related quality of life. Each treatment option has a distinct side effect profile. Brachytherapy is notably for adverse effects on urinary continence, urinary obstruction/irritative symptoms, bowel function and erectile function (though effects on erectile function are less than other treatment options). Radical prostatectomy is primarily associated with adverse effects on continence and erectile function. Cryotherapy is associated with the greatest decline in erectile function but relative preservation of continence. 

Presented By: Paul McClain 
Co-authors: Andrew Wang, Jack Lambert, Shaun Wason, Michael Williams, John Malcolm, Kurt McCammon, Michael Fabrizio, Robert Given 

Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA