Prostate cancer treatment and quality of life

Self-reported quality of life as a predictor of mortality in renal cell carcinoma

BACKGROUND

This study evaluated the utility of self-reported quality of life (QOL) metrics in predicting mortality among all-comers with renal cell carcinoma (RCC) and externally tested the findings in a registry of patients with small renal masses.

METHODS

The Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) captured QOL metrics composed of mental component summary (MCS) and physical component summary (PCS) scores. Regression models assessed associations of MCS and PCS with all-cause, RCC-specific, and non-RCC-specific mortality. Harrell's concordance statistic (the C-index) and the Akaike information criterion (AIC) determined predictive accuracy and parsimony, respectively. Findings were tested in the prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry.

RESULTS

In SEER-MHOS, 1494 patients had a median age of 73.4 years and a median follow-up time of 5.6 years. Each additional MCS and PCS point reduced the hazard of all-cause mortality by 1.3% (95% CI, 0.981-0.993; P < .001) and 2.3% (95% CI, 0.971-0.984; P < .001), respectively. Models with QOL metrics demonstrated higher predictive accuracy (C-index, 72.3% vs 70.1%) and parsimony (AIC, 9376.5 vs 9454.5) than models without QOL metrics. QOL metrics exerted a greater effect on non-RCC-specific mortality than RCC-specific mortality. External testing in the DISSRM registry confirmed these findings with similar results for all-cause mortality.

CONCLUSIONS

Models with self-reported QOL metrics predicted all-cause mortality in patients with RCC with higher accuracy and parsimony than those without QOL metrics. Physical health was a stronger predictor of mortality than mental health. The findings support the incorporation of QOL metrics into prognostic models and patient counseling for RCC.

Racial Disparities in Sexual Dysfunction Outcomes After Prostate Cancer Treatment: Myth or Reality?

Among diverse subject areas in the field of prostate cancer management, treatment-related sexual dysfunction complications persist today as a significant potential problem for all men receiving treatment for this disease. The conjecture that African-American men are disproportionately affected by this problem among ethnic groups is not trivial and warrants attention in view of the possibility that its risk profile, whether real or perceived, may influence clinical management decisions impacting survival outcomes in this high-prostate cancer-risk population. A literature review was performed to define the occurrence and significance of sexual dysfunction after prostate cancer treatment in African-American men, with an emphasis on clinically localized treatment. Data retrieved from population-based as well as single-center investigations are conflicting with regard to the extent and quality of life relevance of sexual dysfunction following prostate cancer treatments in African-American men, relative to that of ethnically different counterparts. Some reports suggest a relatively greater trend in African-American men than other ethnic groups toward obtaining clinical management for sexual dysfunction and experiencing psychosocial effects from it, lending additional support for the possibly greater effect of this problem in African-American men. Although further studies are needed to define sexual dysfunction after prostate cancer treatment and ascertain its bother and impact on quality of life in African-American men, survivorship care that encompasses sexual dysfunction management should proceed with appropriate attention given to cultural, educational, and psychosocial variables.

Assessment of postoperative quality of life: comparative study between laparoscopic and minimum incision endoscopic radical prostatectomies

BACKGROUND

To investigate the changes in postoperative quality of life (QOL) in patients with prostate cancer who underwent laparoscopic radical prostatectomy (LRP) or minimum incision endoscopic radical prostatectomy (MIE-RP).

METHODS

This study included a total of 115 Japanese patients with clinically localized prostate cancer who underwent either LRP or MIE-RP and were subsequently followed for more than 12 months. Before and 12 months after surgery, health-related QOL and disease-specific QOL were assessed using the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) and the Expanded Prostate Index Composite (EPIC), respectively.

RESULTS

LRP and MIE-RP were performed in 57 and 58 patients, respectively, and there were no significant differences in major clinicopathological parameters between these two groups. There were no significant differences in perioperative outcomes between the two groups except for the estimated blood loss, which was lower in the LRP group. There were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the SF-8 survey. Of the fourteen scores evaluated by the EPIC survey, postoperative scores for urinary summary, sexual summary, urinary function, urinary incontinence and sexual function were significantly worse than these preoperative scores in both LRP and MIE-RP groups, while there were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the EPIC survey.

CONCLUSIONS

The postoperative QOL status in patients undergoing MIE-RP appeared to be equivalent to that in those undergoing LRP.

Radical prostatectomy versus watchful waiting for prostate cancer

BACKGROUND

The lack of evidence regarding the effectiveness of treatment options for clinically localised prostate cancer continues to impact on clinical decision-making. Two such options are radical prostatectomy (RP) and watchful waiting (WW). WW involves providing no initial treatment and monitoring the patient with the intention of providing palliative treatment if there is evidence of disease progression.

OBJECTIVES

To compare the beneficial and harmful effects of RP versus WW for the treatment of localised prostate cancer.

SEARCH STRATEGY

MEDLINE, EMBASE, The Cochrane Library, ISI Science Citation Index, DARE and LILACS were searched through 30 July 2010.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing the effects of RP versus WW for clinically localised prostate cancer.

DATA COLLECTION AND ANALYSIS

Data extraction and quality assessment were carried out independently by two authors.

MAIN RESULTS

Two trials met the inclusion criteria. Both trials commenced prior to the widespread availability of prostate-specific antigen (PSA) screening; hence the results may not be applicable to men with PSA-detected disease.One trial (N = 142), conducted in the US, was judged to be of poor quality. All cause (overall) mortality was not significantly different between RP and WW groups after fifteen years of follow up (Hazard Ratio (HR) 0.9 (95% Confidence Interval (CI) 0.56 to 1.43).The second trial (N = 695), conducted in Scandinavia, was judged to be of good quality. After 12 years of follow up, the trial results were compatible with a beneficial effect of RP on the risks of overall mortality, prostate cancer mortality and distant metastases compared with WW but the precise magnitude of the effect is uncertain as indicated by the width of the confidence intervals for all estimates (risk difference (RD) -7.1% (95% CI -14.7 to 0.5); RD -5.4% (95% CI -11.1 to 0.2); RD -6.7% (95% CI -13.2 to -0.2), respectively).        Compared to WW, RP increased the absolute risks of erectile dysfunction (RD 35% (95% CI 25 to 45)) and urinary leakage (RD 27% (95% CI 17 to 37)). These estimates must be interpreted cautiously as they are derived from data obtained from a self-administered questionnaire survey of a sample of the trial participants (N = 326), no baseline quality of life data were obtained and nerve-sparing surgery was not routinely performed on trial participants undergoing RP.

AUTHORS' CONCLUSIONS

The existing trials provide insufficient evidence to allow confident statements to be made about the relative beneficial and harmful effects of RP and WW for patients with localised prostate cancer. The results of ongoing trials should help to inform treatment decisions for men with screen-detected localised prostate cancer.

Patient satisfaction with health-related quality of life: implications for prognosis in prostate cancer

PURPOSE

The goal of this study was to evaluate the association between patient satisfaction with health-related quality of life (HRQOL), as measured by the Ferrans and Powers Quality of Life Index (QLI), and survival in patients with prostate cancer treated in an integrative cancer treatment setting.

MATERIALS AND METHODS

This is a case series of 230 histologically confirmed stage I-IV prostate cancers treated at Cancer Treatment Centers of America. Quality of Life Index measures overall HRQOL and HRQOL in 4 major subscales: health and physical, social and economic, psychological and spiritual, and family. Study patients were dichotomized into 2 groups based on the median scores for all QLI subscales. Kaplan- Meier and log-rank tests were used to evaluate survival. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of HRQOL and clinical factors.

RESULTS

Patient satisfaction with health and physical (P = .0001), psychological and spiritual (P = .03), family (P = .02), and overall HRQOL (P = .0001) were statistically significantly associated with survival upon univariate analysis. Upon multivariate analysis, patient satisfaction with the health and physical subscale was found to be predictive of survival (P = .04), independent of the effects of previous treatment history and Gleason score.

CONCLUSION

This study suggests that baseline patient satisfaction with health and physical function, as measured by the QLI, provides useful prognostic information in patients with prostate cancer, independent of previous treatment history and Gleason score. The QLI Index can be used as a stratification variable in the oncology clinic to aid in medical decision-making.