A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy

Purpose: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after 3 different treatments fo r clinically localized prostate cancer. Methods and Materials: Ninety men with T1-T2 adenocarcinoma of tile prostat e were treated with curative intent between May 1998 and June 1999 and comp leted a quality-of-life Functional Assessment of Cancer Therapy-Prostate (F ACT-P) questionnaire before treatment (T0) and 1 month (T1), 3 months (T3), and 12 months (T12) after treatment. Forty-four men were treated with perm anent source interstitial brachytherapy (IB), 23 received external beam rad iotherapy (EBRT), and 23 men were treated with radical prostatectomy (RP). The mean age of the entire study population was 65.9 years (median 67, rang e 42-79). The mean pretreatment prostate-specific antigen level of the enti re study population was 6.81 ng/mL (median 6.25, range 1.33-19.6). The Glea son score was less than or equal to6 in 65 (72%) of 90. The repeated measur es analysis of variance and analysis of covariance were conducted on all qu ality-of-life and urinary outcome measures. Results: A comparison of the demographic characteristics of the 3 treatment groups demonstrated significant differences. The men treated with RP were significantly younger than the men in either the 113 or EBRT group (median age 61.0 RP, 67.1 IB, 68.8 EBRT; p = 0.0006). The men in the IB group were more likely to have a Gleason score of less than or equal to6 than the EBRT group (Gleason score less than or equal to6, 86% IB and 48% EBRT; p = 0.01 5). The mean score (standard deviation) at T0, T1, T3, and T12 for the FACT -P questionnaire for each group was as follows: IB 138.4 (17.0), 120.5 (21. 7), 130.0 (18.4), and 138.5 (14.2); EBRT 137.1 (12.1), 129.5 (21.0), 134.4 (19.2), and 136.9 (15.6); and RP 138.3 (14.7), 117.7 (18.3), 134.4 (17.8), and 140.4 (14.9), respectively. Statistically significant differences over time were observed for the FACT-P in the 113 and RP groups (p < 0.0001), bu t not for the EBRT group (p = 0.08). The examination of the subscales withi n the FACT-P instrument demonstrated statistically significant changes over time in the IB and RP groups for the following: physical well-being, funct ional well-being, and prostate cancer symptoms. After adjusting for age, ra ce, T stage, Gleason score, use of hormonal therapy, and baseline FACT-P sc ores, statistically significant differences in the FACT-P score at T1 accor ding to treatment group were observed. At T12, the FACT-P scores were not s ignificantly different than the baseline FACT-P scores for any group. Conclusions: The results of this analysis suggest that significant decrease s in HRQOL, as measured by the FACT-P instrument, are evident in the first month after IB or RP, but not after EBRT. One year after treatment, however , the FACT-P scores were not statistically different from the baseline meas ures for any group. For all treatment groups, most of the HRQOL decreases w ere observed in the physical, functional, and prostate cancer-specific doma ins. These results suggest that the HRQOL changes are likely to be treatmen t-specific, further emphasizing the importance of a randomized trial compar ing the different treatment options in this population of men. (C) 2001 Els evier Science Inc.