Baseline Function Predicts Long-Term QOL After Prostate Cancer Therapy

Last Updated: 2009-07-21 8:00:35 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The outcome of treatment for early prostate cancer depends on the patient"s sexual, bowel and urinary function at baseline. These factors also influence the type of treatment the patient will receive, according to a prospective cohort study.

In the past, "prospective studies presented both baseline and outcome quality of life (QOL) data as mean scale scores for entire cohorts, without any stratification by pretreatment status," senior author Dr. James A. Talcott and co-investigators write in the Journal of Clinical Oncology released early online July 20, 2009.

To more clearly convey the impact of treatment to patients choosing among localized prostate cancer treatments, Dr. Talcott"s team recast the numerical scores of the Prostate Cancer Symptom Indices into categories of normal, intermediate, and poor. Responses were collected from 409 patients 3 years after they were treated with radical prostatectomy, external-beam radiation therapy or brachytherapy.

"Different levels of baseline sexual, bowel, and urinary function produced distinctive treatment-related changes from baseline to 36 months," Dr. Talcott, from the Massachusetts General Hospital in Charlestown, and colleagues report.

Their findings indicate that, in general, patients with normal baseline function, and therefore greater room for lost function, reported greater levels of dysfunction than patients with intermediate or poor function at baseline.

On the other hand, sexual dysfunction at baseline was highly prevalent, and all three treatment modalities produced large increases in sexual dysfunction scores. Patients with normal baseline who underwent brachytherapy tended to have better preserved function than any of the other groups.

Brachytherapy also was associated with "surprisingly large improvement" among patients with intermediate sexual function at baseline.

Patients with initially poor scores for urinary obstruction/irritation improved the most in this area, particularly those who had surgery or external beam radiation therapy.

Summing up, Dr. Talcott and associates suggest: "Our analysis using functional levels may permit more fine-grained and patient-specific understanding of the impact of localized prostate cancer treatment on the patient and, in turn, provide more individualized counseling to patients about treatments that will affect them for the rest of their lives."

In critiquing the group"s approach, Dr. Mark S. Litwin from the University of California, Los Angeles, maintains, "With their simplistic approach, Chen et al. have harnessed the key constituents of quality in a manner that is at once elemental and plenary."

"This study ratifies the paramount importance of quality of life during the long arc of prostate cancer survivorship."

Source:

J Clin Oncol 2009;27.


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