Comparative quality-of-life analysis after radical prostatectomy or external beam radiation for localized prostate cancer

Objectives. To determine and compare quality-of-life (QOL) evaluations from patients who received external beam radiation therapy or radical prostatec tomy for the treatment of localized prostate cancer, and to compare differe nces in QOL assessments for urinary and sexual function after radical prost atectomy as reported by patient and physician. Methods. Two hundred three patients treated by radical prostatectomy and 25 7 patients treated by external beam irradiation, all beyond 12-month follow -up after therapy, responded to a QOL questionnaire. The difference in resp onses with regard to bladder, bowel, and sexual function, overall satisfact ion with treatment, and choice of the same treatment were assessed. Satisfa ction with and choice of the same treatment were also specifically assessed according to bowel and bladder function and current disease status. The me dical records of patients treated by radical prostatectomy were reviewed by an independent data manager to record the physician's assessment of contin ence and sexual function for comparison with that patient's assessment as n oted in the questionnaire. Results. Problems with urinary continence were more frequent among patients treated by radical prostatectomy; problems with gastrointestinal function were more frequent after irradiation. Sexual dysfunction was similar in bot h groups, although surgical patients experienced a greater impact on sexual relationships. The physician estimates of urinary continence were more fav orable than the patient-reported outcomes. However, the physician estimate of sexual function closely approximated that of the patient. Preservation o f sexual function among patients who underwent nerve-sparing surgery was di sappointingly low. Only for the response to the question dealing with diffi culty in achieving an erection was there a statistically significant benefi t for patients receiving nerve-sparing versus non-nerve-sparing procedures. Patient satisfaction with and choice of the same treatment varied accordin g to function and current disease status. Patients who had incontinence or bower dysfunction or had evidence of recurrent disease were statistically l ess likely to choose the same treatment again when compared with functional and disease-free counterparts. Because irradiated patients were on average 6 years older than surgical patients, responses were adjusted for age; adj ustment for age did not alter results. Conclusions. QOL is determined by the treatment received, by the assessment source, and by the patient's function and disease status at the time of as sessment. Prospective and longitudinal studies will more accurately quantif y immediate and chronic alterations in QOL. Uniformity of evaluation throug h consolidation of QOL instruments will permit more accurate cross-series a nd cross-treatment comparisons. (C) 1999, Elsevier Science Inc.