INFLUENCE OF UROLOGICAL MORBIDITY ON QUALITY-OF-LIFE IN PATIENTS WITHPROSTATE-CANCER

Objective: To evaluate the prevalence of urological morbidity in patie nts with prostate cancer and its influence on global quality of life ( QL). Method: 379 patients with prostate cancer completed several quest ionnaires (EORTC QLQ-C33, I-PSS, PAIS [sexuality]) and were grouped ac cording to the type of treatment they had undergone: observation only (n = 57), androgen deprivation (n = 112), radiotherapy (n = 114) and r adical prostatectomy (n = 96). A group of 86 urologists also completed the questionnaires, imagining that they had stable prostate cancer an d had been undergoing androgen deprivation for at least 1 year. Their responses were compared with those from patients who had undergone and rogen deprivation. Results: In all patient groups urinary symptoms wer e mostly mild to moderate but 12% of patients who had undergone radiot herapy and 11% of hormonally treated patients described severe symptom s. Severe urinary leakage occurred in 16% of patients who had undergon e radical prostatectomy. 22% of all patients were impotent before trea tment; after treatment sexual life was considerably disturbed in all p atients except those who had undergone observation only. Fatigue was a general problem in all patients. In the logistic regression analysis fatigue and lower urinary tract symptoms (LUTS), but not disturbance o f sexual life or urinary leakage, were correlated with global QL. In t he doctor-patient comparison, doctors underestimated the disturbance o f sexual life in patients who had undergone androgen deprivation thera py but overestimated the impairment of QL and psychological distress e xperienced by these patients. Conclusions: LUTS and fatigue are indepe ndent predictive factors for global QL after initial treatment in pati ents with prostate cancer. Radiotherapy of the prostate leads to more significant morbidity than was generally anticipated by doctors. The d isagreement between doctors' and patients' assessments of QL following treatment indicates the necessity for further systematic QL evaluatio n in these patients.