Quality of life after treatment for localized prostate cancer: Differencesbased on treatment modality

Purpose: Brachytherapy with (103)palladium ((103) Pd) is an increasingly ad ministered treatment modality for localized prostate cancer. We compared ge neral and disease specific health related quality of life after Pd-103 trea tment, radical prostatectomy and external beam radiation therapy given duri ng the same time frame. Materials and Methods: We performed a retrospective cross-sectional survey study of patients treated at a single community medical center between 1995 and 1999. We mailed 5 validated health related quality of life survey inst ruments to 269, 142 and 222 men who underwent radical prostatectomy, Pd-103 treatment and external beam radiation therapy, respectively, with a respon se rate of greater than 80% in all groups. Results: General health related quality of life assessed by the SF-36 showe d the same scores in patients who underwent prostatectomy and Pd-103 treatm ent. The University of California-Los Angeles Prostate Cancer Index was use d to assess bowel, urinary and sexual function/bothersomeness. External bea m radiation therapy reported was associated with worse bowel function and g reater bowel bothersomeness. Prostatectomy was associated with worse urinar y function compared to Pd-103 and external beam radiation therapy. Prostate ctomy was associated with worse sexual function than Pd-103 or external bea m radiation therapy, although nerve sparing surgery and erectile aids minim ized the difference. American Urological Association symptom scores were in itially higher for Pd-103 but became equal to those in the other groups in patients treated greater than 12 months from survey time. Disease-free men who underwent prostatectomy and Pd-103 brachytherapy were equally confident that cancer would not recur in the future. Satisfaction rates were equival ent and biochemical failure significantly decreased satisfaction in all gro ups. Conclusions: While general health related quality of life was mostly unaffe cted by the 3 most common treatments for prostate cancer, there were differ ences in bowel, urinary and sexual function. This information may aid patie nts in the decision making process.