Quality of life three years after diagnosis of prostate...

BMJ 2009; 339:b4817 doi: 10.1136/bmj.b4817 (Published 27 November 2009)
Cite this as: BMJ 2009; 339:b4817
Research
Quality of life three years after diagnosis of localised prostate cancer: population based cohort study
1. David P Smith, research coordinator1,
2. Madeleine T King, director of quality of life office2,
3. Sam Egger, statistician1,
4. Martin P Berry, director of cancer services3,
5. Phillip D Stricker, urologist4,
6. Paul Cozzi, urologist5,
7. Jeanette Ward, adjunct professor6,
8. Dianne L O’Connell, senior epidemiologist1,
9. Bruce K Armstrong, professor of public health7
+ Author Affiliations
1. 1Cancer Council, Kings Cross, New South Wales 1340, Australia
2. 2Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, New South Wales 2006, Australia
3. 3Liverpool Cancer Therapy Centre, Liverpool, New South Wales 2170, Australia
4. 4St Vincent’s Prostate Cancer Centre, St Vincent’s Clinic, Darlinghurst, New South Wales 2010, Australia
5. 5Department of Urology, St George Hospital, Kogarah, New South Wales 2217, Australia
6. 6Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
7. 7Sydney School of Public Health, University of Sydney, New South Wales 2006, Australia
1. Correspondence to: DP Smith dsmith@nswcc.org.au
Accepted 29 September 2009 Next Section

Abstract
Objective To quantify the risk and severity of negative effects of treatment for localised prostate cancer on long term quality of life.
Design Population based, prospective cohort study with follow-up over three years.
Setting New South Wales, Australia.
Participants Men with localised prostate cancer were eligible if aged less than 70 years, diagnosed between October 2000 and October 2002, and notified to the New South Wales central cancer registry. Controls were randomly selected from the New South Wales electoral roll and matched to cases by age and postcode.
Main outcome measures General health specific and disease specific function up to three years after diagnosis, according to the 12 item short form health survey and the University of California, Los Angeles prostate cancer index.
Results 1642 (64%) cases and 495 (63%) eligible and contacted controls took part in the study. After adjustment for confounders, all active treatment groups had low odds of having better sexual function than controls, in particular men on androgen deprivation therapy (adjusted odds ratio (OR) 0.02, 95% CI 0.01 to 0.07). Men treated surgically reported the worst urinary function (adjusted OR 0.17, 95% CI 0.13 to 0.22). Bowel function was poorest in cases who had external beam radiotherapy (adjusted OR 0.44, 95% CI 0.30 to 0.64). General physical and mental health scores were similar across treatment groups, but poorest in men who had androgen deprivation therapy.
Conclusions The various treatments for localised prostate cancer each have persistent effects on quality of life. Sexual dysfunction three years after diagnosis was common in all treatment groups, whereas poor urinary function was less common. Bowel function was most compromised in those who had external beam radiotherapy. Men with prostate cancer and the clinicians who treat them should be aware of the effects of treatment on quality of life, and weigh them up against the patient’s age and the risk of progression of prostate cancer if untreated to make informed decisions about treatment.
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Introduction
Survival after diagnosis of prostate cancer has increased substantially in the past two decades. Five year relative survival for localised prostate cancer is almost 100% in Australia1 and the United States.2 Observational studies show that different treatment options offer nearly equal survival rates3; therefore, quality of life after treatment should be a major consideration in treatment decision making. Dissatisfaction with care in some men may be owing, in part, to a lack of accurate and

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