Changes in quality of life following treatment for early prostate cancer

Objectives. To explore the effects of urinary, bowel, and sexual symptoms f ollowing treatment for early (nonmetastatic) prostate cancer on health-rela ted quality of life through an examination of the responsiveness of the Med ical Outcomes Study Short Form Health Survey (SF-36). Methods. We conducted a prospective observational cohort study of 125 men w ith early prostate cancer who underwent either radical prostatectomy or rad ical, external beam radiotherapy. Patients completed questionnaires, which included assessments of urinary, bowel, and sexual symptoms and the SF-36 a t the time of their clinical consultation prior to deciding on primary ther apy and at 3 and 12-month follow-up, Results. Although cross-sectional analysis showed substantial associations between symptoms and the eight scales of the SF-36 12 months after the init iation of treatment, longitudinal analyses of changes in these scales showe d only modest effects. Three scales registered changes associated with the development of new symptoms: General Health Perceptions, Vitality, and Soci al Function. Role Performance with Emotional Limitations demonstrated a sur prising response: slight improvements in men with new symptoms, compared wi th substantial gains in men who survived treatment without developing new u rinary, bower, or sexual symptoms. Overall, the SF-36 demonstrated a patter n of decline at 3 months and recovery to baseline at 12 months. Rather than registering declines in response to increasing symptoms, negative changes occurred primarily in men who presented symptoms prior to treatment and who se symptoms were unchanged 12 months later. Conclusions. The SF-36 is associated with the presence of physical symptoms but demonstrates a complicated pattern of change following treatment and t he development of new urinary, bowel, and sexual problems. Multidimensional approaches to the outcomes of treatment for early prostate cancer help to clarify the magnitude of both gains and losses in quality of life. UROLOGY 53: 161-168, 1999. (C) 1999, Elsevier Science Inc. All rights reserved.