Health-related Quality of Life in Patients with Advanced Prostate Cancer: A Systematic Review.

The assessment of "soft" endpoints such as health-related quality of life (HRQOL) is increasingly relevant when evaluating the optimal treatment sequence of novel therapeutic options in patients with advanced prostate cancer (PCa).

To systematically review contemporary data regarding HRQOL outcomes in patients with advanced PCa.

A systematic review of the literature published between January 2011 and March 2019 was performed using the PubMed/Medline Database. In total, 873 articles were screened, and 14 articles including 12 661 patients were selected for synthesis and included in the current analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and European Association of Urology recommendations.

Regarding HRQOL assessment, the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire was used in 11 of 14 studies, the European Quality of Life 5-Dimensions (EQ-5D) questionnaire in six of 14 studies, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) in two of 14, and its prostate-specific amendment QLQ-PR25 was used in one of 14 studies. Three studies included patients with metastatic castration-sensitive prostate PCa, and found beneficial HRQOL effects for abiraterone acetate and docetaxel compared with standard androgen deprivation therapy. Two studies included patients with nonmetastatic castration-resistant PCa, and positive HRQOL effects for enzalutamide and apalutamide were observed. Nine studies focused on patients with metastatic castration-resistant PCa. Hereby, beneficial HRQOL outcomes were described for enzalutamide, abiraterone acetate, and radium-223. Evidence synthesis was mostly based on studies with a low risk of bias based on standardized risk of bias assessment. Limitations include hampered comparability between different validated questionnaires, lack of baseline values, and unclear impact of supportive care on HRQOL outcomes.

There is strong evidence from several phase III trials supporting a beneficial effect of current systemic treatment options on HRQOL outcomes in patients with advanced PCa compared with standard androgen deprivation therapy.

In this systematic review, we provide an overview of contemporary data from large clinical trials on the effect of current treatment strategies on patients' health-related quality of life (HRQOL). We summarize the assessment tools that have been used to measure HRQOL and show that there are robust data for positive HRQOL effects of numerous agents in different clinical stages of advanced prostate cancer.

European urology focus. 2020 Feb 20 [Epub ahead of print]

Alexander Kretschmer, Guillaume Ploussard, Isabel Heidegger, Igor Tsaur, Hendrik Borgmann, Cristian Surcel, Romain Mathieu, Pieter de Visschere, Massimo Valerio, Roderick C N van den Bergh, Giancarlo Marra, Constance Thibault, Piet Ost, Giorgio Gandaglia, Derya Tilki, EAU-YAU Prostate Cancer Working Party

Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany. Electronic address: ., Department of Urology, La Croix du Sud Hospital, Toulouse, France; Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France., Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany., Department of Urology, Fundeni Clinical Institute, University of Medicine and Pharmacy, Carol Davila Bucharest, Bucharest, Romania., Department of Urology, CHU Rennes, Rennes, France., Department of Radiology, Ghent University Hospital, Ghent, Belgium., Department of Urology, CHUV Lausanne, Switzerland., Department of Urology, Antonius Hospital, Utrecht, The Netherlands., Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy., Department of Medical Oncology, Hôpital Européen Georges-Pompidou, Paris, France., Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium., Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital-Hamburg Eppendorf, Hamburg, Germany.