Effect of treatment on quality of life among men with clinically localizedprostate cancer

BACKGROUND. Quality-of-life outcomes are an important consideration for pat ients evaluating therapeutic options for localized prostate cancer. OBJECTIVES. The objective of this study was to describe the effect of treat ment choice on change in health-related quality of life (HRQOL) among men w ith clinically localized prostate cancer. RESEARCH DESIGN. This was a prospective observational study. SUBJECTS. The study subjects were 122 men with clinically localized adenoca rcinoma of the prostate. Forty-two subjects (34%) underwent radical prostat ectomy, 51 (42%) underwent radiation therapy, and 29 (24%) were followed wi th expectant management. MEASURES. The University of California at Los Angeles Prostate Cancer Quali ty of Life Index and the Medical Outcomes Study Short Form-36 were administ ered before and 3 and 12 months after initial treatment. The study used an analysis of covariance model adjusted for baseline differences in clinical and demographic factors. RESULTS. Men who underwent radical. prostatectomy experienced significant d eclines in urinary and sexual function and bother that persisted at 12 mont hs after treatment. Men treated with radiation therapy experienced smaller but significant declines in sexual function and a decline in social functio n. Expectant management patients did not have a significant change in disea se-targeted or generic HRQOL domains. Differential rates of change in urina ry and sexual function between treatment groups persisted after adjustment for differences in pretreatment clinical and demographic factors. CONCLUSIO NS. Men undergoing radical prostatectomy have substantial declines in urina ry and sexual function, and men undergoing radiotherapy have declines in se xual function. Men undergoing expectant management have no change in diseas e-specific or general HRQOL in the first year after treatment.