1
|
Corsini C, Bergengren O, Carlsson S, Garmo H, Hjelm-Eriksson M, Fransson P, Kindblom J, Robinson D, Westerberg M, Stattin P, Carlsson SV. Patient-reported Side Effects 1 Year After Radical Prostatectomy or Radiotherapy for Prostate Cancer: A Register-based Nationwide Study. Eur Urol Oncol 2024; 7:605-613. [PMID: 38233329 PMCID: PMC11102330 DOI: 10.1016/j.euo.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Data on functional and psychological side effects following curative treatment for prostate cancer are lacking from large, contemporary, unselected, population-based cohorts. OBJECTIVE To assess urinary symptoms, bowel disturbances, erectile dysfunction (ED), and quality of life (QoL) 12 mo after robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) using patient-reported outcome measures in the Swedish prostate cancer database. DESIGN, SETTING, AND PARTICIPANTS This was a nationwide, population-based, cohort study in Sweden of men who underwent primary RARP or RT between January 1, 2018 and December 31, 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Absolute proportions and odds ratios (ORs) were calculated using multivariable logistic regression, with adjustment for clinical characteristics. RESULTS AND LIMITATIONS A total of 2557 men underwent RARP and 1741 received RT. Men who underwent RT were older (69 vs 65 yr) and had more comorbidities at baseline. After RARP, 13% of men experienced incontinence, compared to 6% after RT. The frequency of urinary bother was similar, at 18% after RARP and 18% after RT. Urgency to defecate was reported by 14% of men after RARP and 34% after RT. At 1 yr, 73% of men had ED after RARP, and 77% after RT. High QoL was reported by 85% of men after RARP and 78% of men after RT. On multivariable regression analysis, RT was associated with lower risks of urinary incontinence (OR 0.25, 95% confidence interval [CI] 0.19-0.33), urinary bother (OR 0.79, 95% CI 0.66-0.95), and ED (OR 0.54, 95% CI 0.46-0.65), but higher risk of bowel symptoms (OR 2.86, 95% CI 2.42-3.39). QoL was higher after RARP than after RT (OR 1.34, 95% CI 1.12-1.61). CONCLUSIONS Short-term specific side effects after curative treatment for prostate cancer significantly differed between RARP and RT in this large and unselected cohort. Nevertheless, the risk of urinary bother was lower after RT, while higher QoL was common after RARP. PATIENT SUMMARY In our study of patients treated for prostate cancer, urinary bother and overall quality of life are comparable at 1 year after surgical removal of the prostate in comparison to radiotherapy, despite substantial differences in other side effects.
Collapse
Affiliation(s)
- Christian Corsini
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Oskar Bergengren
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Stefan Carlsson
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden; Cancercentrum, Norrlands University Hospital, Umeå, Sweden
| | - Jon Kindblom
- Department of Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Robinson
- Department of Urology, Ryhov Hospital, Jönköping, Sweden
| | - Marcus Westerberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sigrid V Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden.
| |
Collapse
|
2
|
Alberti A, Nicoletti R, Castellani D, Yuan Y, Maggi M, Dibilio E, Resta GR, Makrides P, Sessa F, Sebastianelli A, Serni S, Gacci M, De Nunzio C, Teoh JYC, Campi R. Patient-reported Outcome Measures and Experience Measures After Active Surveillance Versus Radiation Therapy Versus Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies. Eur Urol Oncol 2024:S2588-9311(24)00138-X. [PMID: 38816298 DOI: 10.1016/j.euo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Current management options for localized prostate cancer (PCa) include radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS). Despite comparable oncological outcomes, there is still lack of evidence on their comparative effectiveness in terms of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). We conducted a systematic review of studies comparing PROMs and PREMs after all recommended management options for localized PCa (RP, RT, AS). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane CENTRAL databases in accordance with recommendations from the European Association of Urology Guidelines Office and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All prospective clinical trials reporting PROMs and/or PREMs for comparisons of RP versus RT versus AS were included. A narrative synthesis was used to summarize the review findings. No quantitative synthesis was performed because of the heterogeneity and limitations of the studies available. KEY FINDINGS AND LIMITATIONS Our findings reveal that RP mostly affects urinary continence and sexual function, with better results for voiding symptoms in comparison to other treatments. RT was associated with greater impairment of bowel function and voiding symptoms. None of the treatments had a significant impact on mental or physical quality of life. Only a few studies reported PREMs, with a high rate of decision regret for all modalities (up to 23%). CONCLUSIONS AND CLINICAL IMPLICATIONS All recommended treatments for localized PCa have an impact on PROMs and PREMs, but for different domains and with differing severity. We found significant heterogeneity in PROM collection, so standardization in real-world practice and clinical trials is warranted. Only a few studies have reported PREMs, highlighting an unmet need that should be explored in future studies. PATIENT SUMMARY We reviewed differences in patient reports of their outcomes and experiences after surgical prostate removal, radiotherapy, or active surveillance for prostate cancer. We found differences in the effects on urinary, bowel, and sexual functions among the treatments, but no difference for mental or physical quality of life. Our results can help doctors and prostate cancer patients in shared decision-making.
Collapse
Affiliation(s)
- Andrea Alberti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Rossella Nicoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Rome, Italy
| | - Edoardo Dibilio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Giulio Raffaele Resta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pantelis Makrides
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Mauro Gacci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
| |
Collapse
|
3
|
Zamora V, Garin O, Suárez JF, Gutiérrez C, Guedea F, Cabrera P, Castells M, Herruzo I, Fumadó L, Samper P, Ferrer C, Regis L, Pont À, Ferrer M. Comparative effectiveness of new treatment modalities for localized prostate cancer through patient-reported outcome measures. Clin Transl Radiat Oncol 2024; 44:100694. [PMID: 38021091 PMCID: PMC10663757 DOI: 10.1016/j.ctro.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose There is scarce comparative effectiveness research on the new treatment modalities for localized prostate cancer. We aim to compare through Patient-Reported Outcome Measures (PROMs) the impact of active surveillance, robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and real-time brachytherapy, considering side effects (incontinence, irritative/obstructive urinary symptoms, sexual dysfunction and bowel symptoms) and physical and mental health. Materials and Methods Prospective cohort of men diagnosed with clinically localized prostate cancer (age 50-75y, T1-T2, and low risk including Gleason 3 + 4 in T1c) from 18 Spanish hospitals, followed up to 24 months. Treatment decisions were jointly made by patients and physicians (n = 572). The Expanded Prostate cancer Index Composite (EPIC-26) and Short-Form 36 (SF-36v2) were administered through telephone interviews before and three, six, 12, and 24 months after treatment. To account for correlation among repeated measures, generalized estimating equation models were constructed. All analyses were performed with propensity score weights to solve treatment selection bias. Results The PROMs completion rate at 24 months was 95.0 %. Active surveillance entails the fewest side effects, but with significant sexual (0.4 standard deviations [SD], p < 0.001) and physical health deterioration (0.5 SD, p < 0.001); and moderate mental health improvement (0.4 SD, p = 0.001) at 24 months. Compared with active surveillance, RARP presented greater urinary incontinence (p = 0.030), and IMRT and real-time brachytherapy worse bowel symptoms (p = 0.027 and p = 0.007) at 24 months. Conclusions Most side effects of the new treatment modalities seem to be limited to short-term deteriorations, except for moderate-large urinary incontinence in patients who had undergone RARP and moderate bowel deterioration in patients treated with IMRT or with real-time brachytherapy. Furthermore, patients under active surveillance, IMRT, and real-time brachytherapy showed a moderate improvement in mental health.
Collapse
Affiliation(s)
- Víctor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Patricia Cabrera
- Radiation Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ismael Herruzo
- Radiation Oncology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Carlos Ferrer
- Radiation Oncology Department, Hospital Provincial de Castellón, Castellón, Spain
| | - Lucas Regis
- Urology Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | |
Collapse
|
4
|
Zamora V, Garin O, Suárez JF, Jové J, Castells M, Ferrer F, Gutiérrez C, Guedea F, Boladeras A, Fumadó L, Roselló A, Pastor J, Samper P, Pont À, Ferrer M. Psychometric validation of the Spanish version of the Expanded Prostate Cancer Index Composite-26. World J Urol 2023; 41:3511-3518. [PMID: 37947846 PMCID: PMC10693511 DOI: 10.1007/s00345-023-04691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To assess the validity, reliability, and responsiveness of the Spanish version of the Expanded Prostate cancer Index Composite (EPIC) with 26 items. METHODS Multicentric longitudinal study of patients diagnosed with localized or locally advanced prostate cancer (any T, any N, M0) treated with active surveillance, surgery, external radiotherapy, or brachytherapy. The EPIC-50 was administered initially to the cohort (n = 324 patients), until it was replaced in November 2019 by the EPIC-26 (n = 543), in both groups before treatment and 12 months after. We assessed confirmatory factor analysis (CFA), reliability with Cronbach's alpha coefficient, criterion validity with the intraclass correlation coefficient (ICC), and responsiveness by testing a priori hypotheses on deterioration effect size (ES). RESULTS The CFA confirmed the five-domain structure of the EPIC-26 proposed by the original instrument (comparative fit index = 0.95). The agreement between EPIC-50 (gold standard) and EPIC-26 domains was excellent (ICC > 0.90). Cronbach's alpha was > 0.7 in almost all domains, and the floor effect was near zero, although ceiling effect was higher than 50% in urinary incontinence and bowel domains. Hypothesized changes between before and 12 months after treatment were confirmed: ES > 0.8 in both urinary incontinence and sexual domains among patients who underwent surgery; and ES ranging 0.44-0.48 for bowel and sexual domains in patients treated with external radiotherapy. CONCLUSION The Spanish version of the EPIC-26 has demonstrated adequate metric properties, similar to those of the original version, with acceptable goodness-of-fit indices, good criterion validity, reliability, and responsiveness to detect changes after radical prostatectomy or external radiotherapy.
Collapse
Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Jové
- Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ferran Ferrer
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ana Boladeras
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Alvar Roselló
- Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain
| | - Jorge Pastor
- Radiation Oncology Department, ASCIRES GRUPO BIOMÉDICO, Valencia, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| |
Collapse
|
5
|
Haapiainen H, Murtola TJ, Koskimäki J, Riikonen J, Pakarainen T, Haney CM, Raitanen M, Kaipia A. Robot-assisted versus three-dimensional laparoscopic radical prostatectomy: 12-month outcomes of a randomised controlled trial. BJU Int 2023; 132:505-511. [PMID: 37461186 DOI: 10.1111/bju.16132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To compare functional and oncological outcomes of robot-assisted laparoscopic prostatectomy (RALP) to three-dimensional laparoscopic radical prostatectomy (3D-LRP) at 12 months after surgery. PATIENTS AND METHODS Prospective randomised single-centre study of 145 consecutive men referred to radical prostatectomy in a tertiary referral centre in Finland. Patients were randomised 1:1 to the RALP (N = 75) and 3D-LRP (N = 70) groups. The primary outcome was urinary continence evaluated with the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) incontinence domain score at 12 months after surgery. Secondary outcomes included the use of protective pads at 12 months after surgery, EPIC-26 domain scores of irritative/obstructive, bowel, sexual and hormonal symptoms, positive surgical margin (PSM) rate, and biochemical recurrence (BCR). Complication frequency within the 3-month period after surgery was evaluated according to Clavien-Dindo classification. Statistical significance between groups was analysed using Mann-Whitney, chi-square and Fisher's exact tests. The trial was terminated after interim analysis based on no statistically significant difference in EPIC-26 urinary incontinence domain scores. Altogether 145 patients of the target accrual of 280 patients were recruited. RESULTS Postoperative continence at 12 months after surgery according to the EPIC-26 incontinence domain was 79.25 in both groups (P = 0.4). Between group difference was -5.8 (95% confidence interval -15.2 to 3.6). There was no statistically significant difference in the rates of PSM or BCR between the two surgical modality groups. CONCLUSION We were unable to demonstrate a difference between the RALP and 3D-LRP groups for functional and oncological outcomes at 12 months after surgery.
Collapse
Affiliation(s)
- Henry Haapiainen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Teemu J Murtola
- Department of Urology, TAYS Cancer Center, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Koskimäki
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Jarno Riikonen
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | | | - Caelán M Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Mika Raitanen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Urology, TAYS Cancer Center, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Kaipia
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| |
Collapse
|
6
|
Sælen MG, Hjelle LV, Aarsæther E, Knutsen T, Andersen S, Bentzen AG, Richardsen E, Fosså SD, Haugnes HS. Patient-reported outcomes after curative treatment for prostate cancer with prostatectomy, primary radiotherapy or salvage radiotherapy. Acta Oncol 2023; 62:657-665. [PMID: 37353983 DOI: 10.1080/0284186x.2023.2224051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Trials reporting adverse health outcomes (AHOs) in terms of patient-reported outcome measures (PROMs) after contemporary curative treatment of prostate cancer (PC) are hampered by study heterogeneity and lack of new treatment techniques. Particularly, the evidence regarding toxicities after radiotherapy (RT) with the volumetric arc therapy (VMAT) technique is limited, and comparisons between men treated with surgery, primary radiotherapy (PRT) and salvage radiotherapy (SRT) are lacking. The aim of the study was to evaluate change in PROMs 3 months after treatment with robotic-assisted laparoscopic prostatectomy (RALP), PRT and SRT administered with VMAT. MATERIAL AND METHODS A prospective cohort study of men with PC who received curative treatment at the University Hospital of North Norway between 2012 and 2017 for RALP and between 2016 and 2021 for radiotherapy was conducted. A cohort of 787 men were included; 406 men treated with RALP, 265 received PRT and 116 received SRT. Patients completed the validated PROM instrument EPIC-26 before (pre-treatment) and 3 months after treatment. EPIC-26 domain summary scores (DSSs) were analysed, and changes from pre-treatment to 3 months reported. Changes were deemed clinically relevant if exceeding validated minimally clinically important differences (MCIDs). RESULTS Men treated with RALP reported clinically relevant declining urinary incontinence DSS (-41.7 (SD 30.7)) and sexual DSS (-46.1 (SD 30.2)). Men who received PRT reported worsened urinary irritative DSS (-5.2 (SD 19.6)), bowel DSS (-8.2 (SD 15.1)) and hormonal DSS (-9.6 (SD 18.2)). Men treated with SRT experienced worsened urinary incontinence DSS (-7.3 (SD 18.2)), urinary irritative DSS (-7.5 (SD 14.0)), bowel DSS (-12.5 (SD 16.1)), sexual DSS (-14.9 (SD 18.9)) and hormonal DSS (-23.8 (SD 20.9)). CONCLUSION AHOs 3 months after contemporary curative treatment for PC varied according to treatment modality and worsened in all treatment groups, although most in SRT.
Collapse
Affiliation(s)
- Marie G Sælen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Line V Hjelle
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Erling Aarsæther
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
| | - Tore Knutsen
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Sigve Andersen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Anne G Bentzen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Elin Richardsen
- Department of Pathology, University Hospital of North Norway, Tromsø, Norway
| | - Sophie D Fosså
- Division of Cancer Medicine and Radiotherapy, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| |
Collapse
|
7
|
Huaqi Y, Zheng D, Yongkang M, Shiming Z, Zhenghui S, Zhiwei W, Congyu L, Qian L, Bingqi D, Mingkai Z, Chaoshuai Z, Jiangshan P, Tiejun Y. The significance of transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise in improving urinary continence after radical prostatectomy. Eur J Med Res 2023; 28:171. [PMID: 37179346 PMCID: PMC10182606 DOI: 10.1186/s40001-023-01133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND To determine whether transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise is associated with immediate, early and long-term urinary continence after radical prostatectomy. MATERIALS AND METHODS Data from 114 patients with localized prostate cancer (PC) who underwent RP at Henan Cancer Hospital from November 2018 to April 2021 were included in the retrospective study. Of the 114 patients, 50 patients in the observation group underwent transrectal ultrasound and urologist_dually guided PFME, and 64 patients in the control group underwent verbally_guided PFME. Contractile function of the external urinary sphincter was in the observation group was evaluated. The immediate, early and long-term urinary continence rates were assessed in both groups, and the factors affecting urinary continence were analyzed. RESULTS The urinary continence rate at 2 weeks and 1, 3, 6 and 12 months in the observation group after RP was significantly higher than that in the control group (52.0% vs. 29.7%, 70.0% vs. 39.1%, 82% vs. 57.8, 88% vs. 70.3%, 98.0 vs. 84.4%, p < 0.05). The contractile function of the external urinary sphincter was obviously correlated with urinary continence at multiple visits after RP, except for the 12-month visit. Transrectal ultrasound and urologist-dually guided PFME was verified to be an independent positive factor for urinary continence at 2 weeks and 1, 3, 6 and 12 months using logistic regression analysis. However, TURP was a negative factor for postoperative urinary continence at different times. CONCLUSIONS Transrectal ultrasound and urologist_dually guided PFME had a significant role in improving immediate, early and long-term urinary continence after RP and acted as an independent prognostic factor.
Collapse
Affiliation(s)
- Yin Huaqi
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Du Zheng
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Ma Yongkang
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhao Shiming
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Sun Zhenghui
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Wang Zhiwei
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Li Congyu
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Li Qian
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Dong Bingqi
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhu Mingkai
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhu Chaoshuai
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Peng Jiangshan
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Yang Tiejun
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China.
| |
Collapse
|
8
|
Østergaard LD, Poulsen MH, Jensen ME, Lund L, Hildebrandt MG, Nørgaard B. Health‐related
quality of life the first year after a prostate cancer diagnosis a systematic review. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2023. [DOI: 10.1111/ijun.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Louise Dorner Østergaard
- Department of Urology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Mads Hvid Poulsen
- Department of Urology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Malene Eiberg Jensen
- The Psychiatric Research Unit at Mental Health Centre North Zealand Hillerød Denmark
- Department of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars Lund
- Department of Urology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Nuclear Medicine Odense University Hospital Odense Denmark
| | - Birgitte Nørgaard
- Department of Public Health University of Southern Denmark Odense Denmark
| |
Collapse
|
9
|
Adequacy of sexual care information given to prostate cancer patients receiving radical external beam radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Despite the acknowledged value of providing prostate radiotherapy patients with sexual dysfunction (SD) information, there is little evidence related to patient perceptions of this or the extent to which information is provided to them. This study aimed to critically evaluate the quality and format of SD information given to patients before, during and after radical EBRT to treat prostate cancer.
Method:
Members of UK prostate cancer support groups were asked to complete an anonymous online survey tool seeking opinions of the SD information they were given before, during and after external beam radiotherapy (EBRT).
Results:
There were 56 responses to the survey with over 42% of respondents reporting that they had not received any SD information. Of those who did, 78·1% (25/32) received information before the start of EBRT. Physicians were the most involved in the provision of SD information, with nurses and therapeutic radiographers being underutilised. Responses were mostly negative, or neutral regarding the quality of SD information and the information received about impact on relationships, psychological and emotional health. Many participants wanted more information and support.
Conclusion:
This study demonstrates that prostate cancer patients who have undergone radical EBRT have not received adequate information relating to potential sexual function side effects and the psychological and emotional effects of SD. This information should be included in verbal and written information provided at all stages of the radiotherapy pathway.
Collapse
|
10
|
Kord E, Jung N, Boehm B, Conti G, Kuo HC, Frankel J, Flores J, Levie K, Ho O, Elsamanoudi S, Jiang J, Stroup SP, Musser J, Ernest A, Speir R, Chesnut G, Tausch TJ, Porter C. Prospective quality of life in men choosing open vs. robotic radical prostatectomy: long-term results from a racially diverse multi-institutional database. World J Urol 2022; 40:1427-1436. [DOI: 10.1007/s00345-022-03975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
|
11
|
Fukuda K, Muto S, China T, Koyasu H, Noma Y, Ashizawa T, Hirano H, Kitamura K, Shimizu F, Nagata M, Isotani S, Horie S. Clinical use of expanded prostate cancer index composite-based health-related quality of life outcomes after robot-assisted radical prostatectomy for localized prostate cancer. Prostate Int 2021; 10:62-67. [PMID: 35510095 PMCID: PMC9042679 DOI: 10.1016/j.prnil.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/11/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to assess the longitudinal health-related quality of life (HRQOL) using the Expanded Prostate Cancer Index Composite (EPIC) and HRQOL change between the nerve-sparing technique in Japanese men treated with robot-assisted radical prostatectomy (RARP). Methods A total of 573 patients who received RARP were included in this study. EPIC questionnaire was administered before treatment and up to 36 months after RARP. Clinical recovery was defined as half of the standard deviation of the baseline score for each domain. We divided all patients into recovery group or nonrecovery group. The time from survey to each domain recovery was calculated using the Kaplan–Meier method. We compared the sexual and urinary score change between groups using analysis of variance to confirm the effect of nerve-sparing technique. Results The median age was 67 years (interquartile range, 62–71 years). The mean score of all urinary domains worsened noticeably after 1 month. All postoperative urinary summary, function, and incontinence scores were significantly lower than preoperative scores up to 3 years post-RARP. Postoperative sexual summary and functional scores were significantly lower than preoperative score at all follow-up times throughout the 36 months. The recovery rate for the urinary incontinence domain was the lowest (44.5%), whereas the recovery rate for the urinary irritative–obstructive domain was the highest (73.7%). In the sexual domain, the bother domain had a higher recovery rate (73.0%) than the functional domain (29.7%). Although the recovery of sexual domains was slower compared with other domains, by 36 months after RARP, almost all values had recovered. Compared with other technique groups, bilateral intrafascial nerve-sparing group showed significantly decreased change in subscale scores before and after RARP in several sexual and urinary domain. Conclusion The time course and extent of functional and bother domain recovery documented in this study may prove useful for RARP patient selection in Japan.
Collapse
|
12
|
Vernooij RWM, Cremers RGHM, Jansen H, Somford DM, Kiemeney LA, van Andel G, Wijsman BP, Busstra MB, van Moorselaar RJA, Wijnen EM, Pos FJ, Hulshof MCCM, Hamberg P, van den Berkmortel F, Hulsbergen-van de Kaa CA, van Leenders GJLH, Fütterer JJ, van Oort IM, Aben KKH. Urinary incontinence and erectile dysfunction in patients with localized or locally advanced prostate cancer: A nationwide observational study. Urol Oncol 2020; 38:735.e17-735.e25. [PMID: 32680820 DOI: 10.1016/j.urolonc.2020.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although urinary adverse events after treatment of prostate cancer (CaP) are common, population-based studies on functional outcomes are scarce. The aim of this study is to evaluate the occurrence of urinary incontinence (UI) and erectile dysfunction (ED) in daily clinical practice using a nationwide Dutch cohort of patients with localized or locally advanced CaP. BASIC PROCEDURES Patients were invited to complete the EPIC-26 questionnaire before treatment (baseline) and at 12 and 24 months after diagnosis. We calculated the mean EPIC-26 domain scores, stratified by treatment modality (i.e., radical prostatectomy, external radiotherapy, and no active treatment), and the proportions of patients with UI (defined as ≥ 2 pads per day) and ED (defined as erections not firm enough for sexual intercourse). Logistic regression modeling was used to explore the factors related to UI and ED after surgery. MAIN FINDINGS In total 1,759 patients participated in this study. Patients undergoing radical prostatectomy experienced clinically relevant worsening in the urinary incontinence domain. After excluding patients who reported UI at baseline, 15% of patients with prostatectomy reported UI 24 months after diagnosis. Only comorbidity was associated with UI in surgically treated patients. Regardless of treatment, patients reported a clinically significant reduced sexual functioning over time. Before treatment, 54% of patients reported ED. Among the 46% remaining patients, 87% of patients treated with radical prostatectomy reported ED 24 months after diagnosis, 41% after radiotherapy, and 46% in patients without active treatment. Bilateral nerve-sparing surgery was the only factor associated with ED after 24 months. PRINCIPAL CONCLUSIONS UI and ED frequently occur in patients with localized and locally advanced CaP, in particular after radical prostatectomy. The higher occurrence rate of UI and ED, compared with clinical trial participants, supports the importance of real-world data, which can be used for local treatment recommendations and patient information, but also to evaluate effects of future initiatives, such as treatment centralization and research aimed at improving functional outcomes.
Collapse
Affiliation(s)
- R W M Vernooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - R G H M Cremers
- Department of Urology, Deventer Hospital, Deventer, the Netherlands
| | - H Jansen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - D M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - L A Kiemeney
- Radboud Institute for Health Sciences, Department of Urology, Radboud university medical center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands
| | - G van Andel
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - B P Wijsman
- Department of Urology, Elisabeth-TweeSteden hospital, Tilburg, the Netherlands
| | - M B Busstra
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - E M Wijnen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - F J Pos
- Department of Radiotherapy, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M C C M Hulshof
- Department of Radiotherapy, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - P Hamberg
- Department of Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - F van den Berkmortel
- Department of Oncology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | | | - G J L H van Leenders
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J J Fütterer
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I M van Oort
- Radboud Institute for Health Sciences, Department of Urology, Radboud university medical center, Nijmegen, the Netherlands
| | - K K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Radboud Institute for Health Sciences, Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands.
| |
Collapse
|
13
|
Chen MC, Kilday PS, Elliott PA, Artenstein D, Slezak J, Jacobsen SJ, Chien GW. Neoadjuvant Leuprolide Therapy with Radical Prostatectomy: Long-term Effects on Health-related Quality of Life. Eur Urol Focus 2020; 7:779-787. [PMID: 32165116 DOI: 10.1016/j.euf.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/30/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neoadjuvant androgen ablation (neoadjuvant androgen deprivation therapy [NADT]) is used prior to radical prostatectomy, contrary to guidelines, but its long-term effects on quality of life is unknown. OBJECTIVE To determine the effect of NADT on patient's long-term recovery following surgery. DESIGN, SETTING, AND PARTICIPANTS From March 2011 to August 2013, 5808 men with newly diagnosed prostate were followed up to 24 mo. A cohort of men who received NADT prior to robotic-assisted laparoscopic prostatectomy (RALP; n=51) was compared 1:3 with a matched group that underwent RALP only (n=153). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were matched on Charlson comorbidities, biopsy Gleason score, and node status on final pathology. The Kruskall-Wallis test was used to compare the groups on their bowel, urinary, sexual, and hormonal domains of the 26-item Expanded Prostate Cancer Index Composite at baseline and at 1, 3, 6, 12, 18, and 24 mo postoperatively. RESULTS AND LIMITATIONS The urinary irritative, urinary incontinence, and bowel domains were similar in the two groups during the 24 mo (p=0.832, 0.901, and 0.732, respectively). In the hormonal domain, the NADT group did worse (p<0.001). The sexual domain was also worse for the NADT group. However, when accounting for nerve sparing, there was no significant difference in sexual outcomes between the two groups (p=0.069). CONCLUSIONS Patients who received NADT prior to RALP do not have worse sexual function, but have worse hormonal scores for up to 2yr after surgery. PATIENT SUMMARY Neoadjuvant androgen deprivation therapy (NADT) is administered prior to robotic-assisted laparoscopic prostatectomy (RALP), contrary to clinical guidelines. NADT may not have worse sexual function outcomes up to 2yr after RALP.
Collapse
Affiliation(s)
- Michael C Chen
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Patrick S Kilday
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Peter A Elliott
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Daniel Artenstein
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
14
|
Miyoshi Y, Morizane S, Honda M, Hikita K, Iwamoto H, Yumioka T, Kimura Y, Yoshioka SI, Takenaka A. Health Related Quality of Life in Japanese Patients with Localized Prostate Cancer: Comparative Retrospective Study of Robot-Assisted Laparoscopic Radical Prostatectomy Versus Radiation Therapy. Yonago Acta Med 2020; 63:55-62. [PMID: 32158334 DOI: 10.33160/yam.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/17/2020] [Indexed: 11/05/2022]
Abstract
Background Radical prostatectomy and radiotherapy are standard treatments for localized prostate cancer. When making decisions about treatment, it is important to not only consider medical information such as the patient's age, performance status, and complications, but also the impact on quality of life (QOL) after treatment. Our purpose was to compare health related quality of life (HRQOL) after robot-assisted laparoscopic radical prostatectomy (RARP) versus radiation therapy in Japanese patients with localized prostate cancer retrospectively. Methods Patients with localized prostate cancer receiving RARP or radiotherapy at Tottori University Hospital between October 2010 and December 2014 were enrolled in a retrospective observational study with follow-up for 24 months to December 2016. The Medical Outcome Study 8-Item Short-Form Health Survey was performed before treatment and 1, 3, 6, 12, and 24 months post-treatment. Results Complete responses to the questionnaire were obtained from 154/227 patients receiving RARP, 41/67 patients receiving intensity-modulated radiation therapy, 35/82 patients receiving low dose rate brachytherapy, and 18/28 patients given low dose rate brachytherapy plus external beam radiation therapy. The median physical component summary score of the Medical Outcome Study 8-Item Short-Form Health Survey was significantly lower at 1 month after prostatectomy than radiotherapy, but was similar for both treatments at 3 months, and was significantly higher at 6, 12 and 24 months after prostatectomy. The median mental component summary score was also significantly lower in the prostatectomy group at 1 month, but not from 3 months onwards. Conclusion Our study suggested that HRQOL was inferior at 1 month after RARP, however, recovered at 3 months after RARP and was better than after radiotherapy at 6, 12, and 24 months.
Collapse
Affiliation(s)
- Yoko Miyoshi
- Department of Adult and Elderly Nursing, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shuichi Morizane
- Department of Urology, Tottori University Hospital, Yonago 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Katsuya Hikita
- Department of Urology, Tottori University Hospital, Yonago 683-8504, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tetsuya Yumioka
- Department of Urology, Matsue City Hospital, Matsue 690-8509, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shin-Ichi Yoshioka
- Department of Nursing Care Environment and Mental Health, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| |
Collapse
|
15
|
Crump RT, Peterson A, Charbonneau C, Carlson KV, Sutherland JM, Baverstock RJ. Evaluating the measurement properties of the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) with a multicenter cohort. Can Urol Assoc J 2019; 14:111-117. [PMID: 31702548 DOI: 10.5489/cuaj.5997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the psychometric properties of the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) for measuring the quality of life in patients treated for localized prostate cancer. The EPIC-26 is a patient-reported outcome instrument recommended for use with patients treated for localized prostate cancer. METHODS This study is based on data collected prospectively between September 2014 and February 2017 in Alberta, Canada. Men were treated with either radical prostatectomy or radiation therapy and administered the EPIC-26. Responses to the EPIC-26 were the primary outcome. Construct validity was measured using confirmatory factor analysis. Reliability was measured using Chronbach's alpha and item-total correlation. Ceiling and floor effects were also investigated. RESULTS EPIC-26 response data from 205 participants (prostatectomy =138; radiation=60; both=7) were used in this analysis. The EPIC-26 was administered an average of 33.8 weeks after treatment. The confirmatory factor analysis model did not meet the threshold for adequate fit. Several items had near-zero factor loadings and were non-significant. Four out of the EPIC-26's five domains met the acceptable reliability threshold based on Cronbach's alpha. Ceiling effects were observed in four out of five domains. CONCLUSIONS The EPIC-26 demonstrated poor construct validity, adequate reliability, and large ceiling effects. Several issues were observed, suggesting that the instrument's five domains were not well-defined by their respective items. The original EPIC's conceptual framework should be reviewed and the shortened instrument revised to improve its performance for measuring post-treatment quality of life.
Collapse
Affiliation(s)
- R Trafford Crump
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Alex Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | | | - Kevin V Carlson
- Department of Surgery, University of Calgary, Calgary, AB, Canada.,vesia [Alberta Bladder Centre], Calgary, AB, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Richard J Baverstock
- Department of Surgery, University of Calgary, Calgary, AB, Canada.,vesia [Alberta Bladder Centre], Calgary, AB, Canada
| |
Collapse
|
16
|
Ernstmann N, Herden J, Weissbach L, Karger A, Hower K, Ansmann L. Prostate-specific health-related quality of life and patient-physician communication - A 3.5-year follow-up. PATIENT EDUCATION AND COUNSELING 2019; 102:2114-2121. [PMID: 31399225 DOI: 10.1016/j.pec.2019.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study is to examine associations between prostate-specific health-related quality of life (HRQOL) and aspects of patient-physician communication in localized prostate cancer treatment. METHODS Data of patients with localized prostate cancer were collected at 6-month intervals over a 3.5-year period within a prospective, observational study (HAROW). Data collection comprised D'Amico risk categories, the Charlson Comorbidity Index, patient-physician communication (information, shared decision making, support, devotion), and prostate-specific HRQOL (incontinence aid, urinary symptoms, bowel symptoms, hormonal treatment-related symptoms, sexual functioning, sexual activity). Data of N = 1722 patients undergoing radical prostatectomy were analyzed by longitudinal multilevel analysis. RESULTS The mean patient age was 65 years; 31% had a low risk and 38% an intermediate risk of cancer growth and spread; 73% had a Charlson Comorbidity Index of 0. Significant associations were found between prostate-specific HRQOL and shared decision making, support and devotion. Patient information was not significantly associated with aspects of prostate-specific HRQOL. CONCLUSION Patient reported long term outcomes are associated with aspects of patient-physician communication in prostate cancer patients. Patients feeling involved by their urologists experience less side effects of (surgical) treatment. PRACTICE IMPLICATIONS Special communication training programmes should be developed and implemented for urologists.
Collapse
Affiliation(s)
- Nicole Ernstmann
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Bonn (CIO), Bonn, Germany.
| | - Jan Herden
- Department of Urology, University Hospital Cologne, Cologne, Germany.
| | | | - André Karger
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Kira Hower
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
| |
Collapse
|
17
|
Baunacke M, Schmidt ML, Thomas C, Groeben C, Borkowetz A, Koch R, Chun FKH, Weissbach L, Huber J. Long-term functional outcomes after robotic vs. retropubic radical prostatectomy in routine care: a 6-year follow-up of a large German health services research study. World J Urol 2019; 38:1701-1709. [DOI: 10.1007/s00345-019-02956-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/07/2019] [Indexed: 02/03/2023] Open
|
18
|
Ranasinghe W, de Silva D, Bandaragoda T, Adikari A, Alahakoon D, Persad R, Lawrentschuk N, Bolton D. Robotic-assisted vs. open radical prostatectomy: A machine learning framework for intelligent analysis of patient-reported outcomes from online cancer support groups. Urol Oncol 2018; 36:529.e1-529.e9. [PMID: 30236854 DOI: 10.1016/j.urolonc.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/05/2018] [Accepted: 08/18/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The advantages of Robot-assisted laparoscopic prostatectomy (RARP) over open radical prostatectomy (ORP) in Prostate cancer perioperatively are well-established, but quality of life is more contentious. Increasingly, patients are utilising online cancer support groups (OCSG) to express themselves. Currently there is no method of analysis of these sophisticated data sources. We have used the PRIME-2 (Patient Reported Information Multidimensional Exploration version 2) framework for automated identification and intelligent analysis of decision-making, functional and emotional outcomes in men undergoing ORP vs. RARP from OCSG discussions. METHODS The PRIME-2 framework was developed to retrospectively analyse individualised patient-reported information from 5,157 patients undergoing RARP and 579 ORP. The decision factors, side effects, and emotions in 2 groups were analysed and compared using Chi-squared, t tests, and Pearson correlation. RESULTS There were no differences in Gleason score, Prostate Specific Antigen (PSA), and age between the groups. Surgeon experience and preservation of erectile function (P < 0.01) were important factors in the decision making process. There were no significant differences in urinary, sexual, or bowel symptoms between ORP and RARP on a monthly basis during the initial 12 months. Emotions expressed by patients undergoing RARP were more consistent and positive while ORP expressed more negative emotions at the time of surgery and 3 months postsurgery (P < 0.05), due to pain and discomfort, and during ninth month due to fear and anxiety of pending PSA tests. CONCLUSIONS ORP and RARP demonstrated similar side effect profiles for 12 months, but PRIME-2 enables identification of important quality of life features and emotions over time. It is timely for clinicians to accept OCSG as an adjunct to Prostate cancer care.
Collapse
Affiliation(s)
- Weranja Ranasinghe
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia.
| | - Daswin de Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Tharindu Bandaragoda
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Raj Persad
- North Bristol, NHS Trust, United Kingdom
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Damien Bolton
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| |
Collapse
|
19
|
Kitamura K, China T, Kanayama M, Nagata M, Isotani S, Wakumoto Y, Muto S, Ide H, Horie S. Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy. Prostate Int 2018; 7:54-59. [PMID: 31384606 PMCID: PMC6664308 DOI: 10.1016/j.prnil.2018.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction To determine the clinical predictive factors affecting the recovery from postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP). Materials and methods We consecutively analyzed 320 patients who underwent RARP between January 2012 and March 2015. The restoration of urinary continence was defined as follows: the use of no pads/no leakage of urine or the use of a safety pad. Preoperative covariates were statistically assessed by multivariate logistic regression analysis to investigate their predict factor to recovery of urinary incontinence. Therefore, in this study, we sought to identify predictors of early urinary continence status in a single-center retrospective study of consecutive patients who underwent RARP. Results Continence rates at 1, 3, 6, and 12 months after the catheter was removed were 44%, 71%, 83%, and 93%, respectively. Age, body mass index, and prostate volume had no significant association with urinary continence recovery. In contrast to this, longer preoperative membranous urethral length (MUL) was significantly associated with earlier postoperative continence recovery. Multivariate analysis demonstrated that longer preoperative MUL is significantly associated with continence recovery at 1 month (P = 0.0235). Conclusion Approximately 70% of patients achieved urinary continence within 3 months after RARP. Multivariate analysis showed that age, body mass index, and prostate volume had no significant association with urinary continence recovery. Preoperative MUL assessed by magnetic resonance imaging was an independent predictor of early recovery from urinary incontinence after RARP.
Collapse
Affiliation(s)
- Kosuke Kitamura
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Mayuko Kanayama
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masayosi Nagata
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Wakumoto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Department of Advanced Informatics for Genetic Disease, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Wang Y, Mossanen M, Chang SL. Cost and cost-effectiveness studies in urologic oncology using large administrative databases. Urol Oncol 2018; 36:213-219. [PMID: 29500134 DOI: 10.1016/j.urolonc.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Urologic cancers are not only among the most common types of cancers, but also among the most expensive cancers to treat in the United States. This study aimed to review the use of CEAs and other cost analyses in urologic oncology using large databases to better understand the value of management strategies of these cancers. METHODS A literature review on CEAs and other cost analyses in urologic oncology using large databases. RESULTS The options for and costs of diagnosing, treating, and following patients with urologic cancers can be expected to rise in the coming years. There are numerous opportunities in each urologic cancer to use CEAs to both lower costs and provide high-quality services. Improved cancer care must balance the integration of novelty with ensuring reasonable costs to patients and the health care system. CONCLUSION With the increasing focus cost containment, appreciating the value of competing strategies in caring for our patients is pivotal. Leveraging methods such as CEAs and harnessing large databases may help evaluate the merit of established or emerging strategies.
Collapse
Affiliation(s)
- Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
21
|
Ling Y, Li C, Zhou K, Guan G, Appleton PL, Lang S, McGloin D, Huang Z, Nabi G. Microscale characterization of prostate biopsies tissues using optical coherence elastography and second harmonic generation imaging. J Transl Med 2018; 98:380-390. [PMID: 29251735 PMCID: PMC5842892 DOI: 10.1038/labinvest.2017.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/01/2017] [Accepted: 10/17/2017] [Indexed: 01/29/2023] Open
Abstract
Photonics, especially optical coherence elastography (OCE) and second harmonic generation (SHG) imaging are novel high-resolution imaging modalities for characterization of biological tissues. Following our preliminary experience, we hypothesized that OCE and SHG imaging would delineate the microstructure of prostate tissue and aid in distinguishing cancer from the normal benign prostatic tissue. Furthermore, these approaches may assist in characterization of the grade of cancer, as well. In this study, we confirmed a high diagnostic accuracy of OCE and SHG imaging in the detection and characterization of prostate cancer for a large set of biopsy tissues obtained from men suspected to have prostate cancer using transrectal ultrasound (TRUS). The two techniques and methods described here are complementary, one depicts the stiffness of tissues and the other illustrates the orientation of collagen structure around the cancerous lesions. The results showed that stiffness of cancer tissue was ~57.63% higher than that of benign tissue (Young's modulus of 698.43±125.29 kPa for cancerous tissue vs 443.07±88.95 kPa for benign tissue with OCE. Using histology as a reference standard and 600 kPa as a cut-off threshold, the data analysis showed sensitivity and specificity of 89.6 and 99.8%, respectively. Corresponding positive and negative predictive values were 99.5 and 94.6%, respectively. There was a significant difference noticed in terms of Young's modulus for different Gleason scores estimated by OCE (P-value<0.05). For SHG, distinct patterns of collagen distribution were seen for different Gleason grade disease with computed quantification employing a ratio of anisotropic to isotropic (A:I ratio) and this correlated with disease aggressiveness.
Collapse
Affiliation(s)
- Yuting Ling
- Division of Cancer Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK,School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Chunhui Li
- Division of Cancer Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK,School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Kanheng Zhou
- Division of Cancer Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK,School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Guangying Guan
- Division of Cancer Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK,School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Paul L. Appleton
- Dundee Imaging Facility, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Stephen Lang
- Department of Pathology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - David McGloin
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Zhihong Huang
- Division of Cancer Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK,School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Ghulam Nabi
- Division of Cancer Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| |
Collapse
|
22
|
Elliott PA, Abdelsayed GA, Kilday PS, Kim BJ, Slezak JM, Chien GW. Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy. World J Urol 2017; 36:21-26. [PMID: 29086019 DOI: 10.1007/s00345-017-2112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. MATERIALS AND METHODS From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90 days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. RESULTS A total of 411 men who completed the baseline survey and at 90 days postoperatively were included. On multivariate linear regression, younger age (p < 0.01), higher preoperative sexual function (< 0.01), single marital status (p = 0.04) and more post-surgery email contacts (p = 0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p = 0.01), higher baseline continence (p < 0.01) and more post-surgery physical therapy visits (p < 0.01) were associated with higher declines. CONCLUSIONS Patients with the poorest quality of life outcomes at 90 days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.
Collapse
Affiliation(s)
- Peter A Elliott
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - George A Abdelsayed
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - Patrick S Kilday
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - Brian J Kim
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
| |
Collapse
|