Long-term morbidity and quality of life in patients with localized prostate cancer undergoing definitive radiotherapy or radical prostatectomy

Purpose: To assess morbidity, side effects, and quality of life (QoL) in pa tients treated for localized prostate cancer with curative aim. Methods and Materials: This descriptive cross-sectional study comprises 154 patients who had undergone definitive radiotherapy (RAD) and 108 patients with radical prostatectomy (PRECT) at the Norwegian Radium Hospital during 1987-1995. At least 1 year after treatment the patients completed several q uestionnaires assessing quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 instrument [EORTC QLQ-C30]), lower urinary tract symptoms (LUTS): International Prostate Symptom Score (IPSS), or sex uality (selected questions from the Psychosocial Adjustment to Illness Scal e [PAIS]). Urinary incontinence and bowel distress were evaluated by ad hoc constructed questionnaires. A control group (OBS) consisted of 38 patients following the watch-and-wait policy. Results: Twenty percent of the patients from the RAD Group had moderate (14 %) or severe (6%) LUTS as compared to 12% in the PRECT group. However, 35% of men from the latter group reported moderate to severe urinary incontinen ce. "Overall" sexuality was moderately or severely impaired in 71% of the P RECT and 50% of the RAD patients. In the former group high age was correlat ed with erectile impotency (p < 0.001). In the RAD comorbidity was associat ed with erectile impotency (p < 0.001). Between 13-38% of the patients reco rded moderate or severe bowel distress (blood per rectum: 13%; bowel cramps : 26%; flatulence: 38%), without significant differences comparing patients who had received conventional small 4-field box radiotherapy and patients who had undergone strictly conformal radiotherapy. Despite malignancy and/o r treatment-related morbidity, QoL was comparable in both groups with respe ctively 9% and 6% RAD and PRECT patients, reporting moderately or severely impaired QoL. In the multivariate analysis physical function, emotional fun ction and fatigue were significantly correlated with QoL, whereas sexuality , lower urinary symptoms, and urinary incontinence correlated with QoL only in the univariate analysis. Conclusion: In spite of considerable malignancy and/or treatment-related mo rbidity QoL was good or only slightly impaired in the majority of patients with localized prostate cancer who presented with stable disease > 1 year a fter definitive radiotherapy or radical prostatectomy with no difference as compared to the age-matched normal population. Clinicians should be aware of the fact that general QoL dimensions (physical function, emotional funct ion, fatigue) are as a rule of greater significance for QoL than sexuality and lower urinary tract symptoms. (C) 1999 Elsevier Science Inc.