Current evidence-based management for clinically localised prostate cancer includes active surveillance, surgery, external beam radiotherapy (EBRT) and brachytherapy. The impact of these treatment modalities on quality of life (QoL) is uncertain.
To systematically review comparative studies investigating disease-specific QoL outcomes as assessed by validated cancer-specific patient-reported outcome measures with at least 1 yr of follow-up after primary treatment for clinically localised prostate cancer.
MEDLINE, EMBASE, AMED, PsycINFO, and Cochrane Library were searched to identify relevant studies. Studies were critically appraised for the risk of bias. A narrative synthesis was undertaken.
Of 11486 articles identified, 18 studies were eligible for inclusion, including three randomised controlled trials (RCTs; follow-up range: 60-72 mo) and 15 nonrandomised comparative studies (follow-up range: 12-180 mo) recruiting a total of 13604 patients. Two RCTs recruited small cohorts and only one was judged to have a low risk of bias. The quality of evidence from observational studies was low to moderate. For a follow-up of up to 6 yr, active surveillance was found to have the lowest impact on cancer-specific QoL, surgery had a negative impact on urinary and sexual function when compared with active surveillance and EBRT, and EBRT had a negative impact on bowel function when compared with active surveillance and surgery. Data from one small RCT reported that brachytherapy has a negative impact on urinary function 1 yr post-treatment, but no significant urinary toxicity was reported at 5 yr.
This is the first systematic review comparing the impact of different primary treatments on cancer-specific QoL for men with clinically localised prostate cancer, using validated cancer-specific patient-reported outcome measures only. There is robust evidence that choice of primary treatment for localised prostate cancer has distinct impacts on patients' QoL. This should be discussed in detail with patients during pretreatment counselling.
Our review of the current evidence suggests that for a period of up to 6 yr after treatment, men with localised prostate cancer who were managed with active surveillance reported high levels of quality of life (QoL). Men treated with surgery reported mainly urinary and sexual problems, while those treated with external beam radiotherapy reported mainly bowel problems. Men eligible for brachytherapy reported urinary problems up to a year after therapy, but then their QoL returned gradually to as it was before treatment.
European urology. 2017 Jul 27 [Epub ahead of print]
Michael Lardas, Matthew Liew, Roderick C van den Bergh, Maria De Santis, Joaquim Bellmunt, Thomas Van den Broeck, Philip Cornford, Marcus G Cumberbatch, Nicola Fossati, Tobias Gross, Ann M Henry, Michel Bolla, Erik Briers, Steven Joniau, Thomas B Lam, Malcolm D Mason, Nicolas Mottet, Henk G van der Poel, Olivier Rouvière, Ivo G Schoots, Thomas Wiegel, Peter-Paul M Willemse, Cathy Yuhong Yuan, Liam Bourke
Department of Urology, Leto Hospital, Athens, Greece., Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK., Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands., Clinical Trials Unit, University of Warwick, UK; Department of Urology, Medical University of Vienna, Austria., Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK., Academic Urology Unit, University of Sheffield, Sheffield, UK., Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy., Department of Urology, University of Bern, Inselspital, Bern, Switzerland., Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK., Department of Radiation Therapy, CHU Grenoble, Grenoble, France., Hasselt, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK., Wales Cancer Bank, Cardiff University, School of Medicine, Health Park, Cardiff, UK., Department of Urology, University Hospital, St. Etienne, France., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France., Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., Department of Urology, University Hospital Groningen, Groningen, The Netherlands., Department of Medicine, McMaster University, Hamilton, ON, Canada., Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK. Electronic address: .