QUALITY-OF-LIFE IN PATIENTS WITH PROSTATIC-CARCINOMA - A REVIEW AND RESULTS OF A STUDY IN N- PROSTATE-SPECIFIC ANTIGEN AS PREDICTOR OF QUALITY-OF-LIFE( DISEASE )

Clinical evaluation in oncology has typically focused on outcome indic ators, while less attention has been paid to how treatment affects qua lity of life (QOL) of the patient. In this article some general aspect s of quality of life are discussed, a short review of published data o n QOL in patients with prostate cancer is given and results of a QOL s tudy executed by the authors on patients with lymph node positive pros tatic cancer are presented. The purpose of the study was to examine th e impact of immediate or delayed treatment (after objective progressio n) in patients with prostatic carcinoma (T1-3 N1-3 M0) on quality of l ife parameters. To this end an extended questionnaire was constructed. Fifty-five patients participated. Assessment was performed twice, in 1994 and 1995. The comparison between patients with and patients witho ut treatment showed in 1994 as well as in 1995 significant differences for hormonal treatment side effects such as sexual functioning and ho t flushes; all of which were experienced more frequently by treated pa tients. In 1994 the treated patients experienced more psychological di stress while in 1995 they showed worse physical function, less energy and more fatigue when compared to patients under surveillance. The pre mise that active treatment would improve the psychological quality of life was not sustained. In addition global health status and quality o f life were identified as independent factors for progression in untre ated patients with lymph node positive prostate cancer. Finally, an in crease in prostate-specific antigen (PSA) in hormonally treated patien ts not only indicated hormonal escape but also a decrease in QOL. In t he past decade the need to assess quality of life (QOL) in patients wi th malignancy has become increasingly recognized. Traditionally clinic ians have mainly focused their attention on the more classical aspects of the evaluation of cancer treatment outcome, such as control of sym ptoms, response to treatment, relapse, and survival, while less attent ion has been paid to how treatment affects QOL. In this article some g eneral aspects of QOL assessment are discussed, a short review of publ ished urological QOL data is given, and finally the results of a QOL s tudy in patients with lymph node positive prostatic carcinoma are pres ented.