EFFECT OF RADICAL PROSTATECTOMY FOR PROSTATE-CANCER ON PATIENT QUALITY-OF-LIFE - RESULTS FROM A MEDICARE SURVEY

Objectives. To assess patient responses to radical prostatectomy and i ts effects. Methods. A national sample was taken of 1072 Medicare pati ents who underwent radical prostatectomy for prostate cancer (1988 thr ough 1990) by mail, telephone, and personal interviews. The effects of the surgery and its complications On these patients' lives were studi ed through: (1) patient ratings of the extent to which sexual and urin ary dysfunctions were ''problems'' in their lives; (2) two general mea sures of quality of life, the Mental Health Index and the General Heal th Index; (3) patient reports of how they felt about the results of tr eatment and whether they would choose surgery again. Results. On avera ge, dripping urine, particularly to the point where subjects were wear ing pads, had a more significant effect on patients than loss of sexua l function; incontinence had significant adverse effects on the measur es of quality of life and self-reported results of surgery. Overall, p ostsurgical patients scored comparatively high on the quality of life measures (similar to a cohort of patients with benigh prostatic hyperp lasia who had undergone transurethral resection of the prostate), repo rted feeling positive about the results (81%), and would choose surgic al treatment again (89%). Nonetheless, there was variability in patien t response to the effects of surgery. Conclusions. The results demonst rate the ability of many Medicare patients to adapt to adverse outcome s, such as loss of sexual function and incontinence. They also provide evidence of the variability of individual patients' responses to surg ical results and reinforce the importance of individualized decision m aking for patients facing a decision about radical prostatectomy for p rostate cancer.