Oncological Results, Functional Outcomes, Quality-of-Life - Radical Prostatectomy Or External Beam Radiation Therapy For Localized Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Cancer / Oncology;  Cancer / Oncology;  Erectile Dysfunction / Premature Ejaculation
Article Date: 03 Aug 2009 - 2:00 PDT

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UroToday.com - Most recently, health-related quality-of-life (HRQOL) after definitive local therapy for prostate cancer has been argued in the patient group with an oncological risk category. ^[1] Prior to such controversy, we thought that posttreatment HRQOL issues or functional outcomes possibly vary among oncological risk categories, and compared both oncological and functional outcomes between patients receiving radical prostatectomy (RP) and those undergoing external beam radiation therapy (EBRT) with risk stratification. ^[2] Indeed, we found that the low- and intermediate-risk patients in the RP group reported poorer urinary function than those in the EBRT group.

However, the sexual function of the low-risk patients in the EBRT group was poorer than that of the RP patients at same risk. Not only in general populations but also in our patient series, sexual function of the low-risk EBRT patients, who were older than those indicated for RP, might be more affected by irradiation. Moreover, in the present study, the fraction of patients receiving neoadjuvant androgen deprivation therapy (ADT) was larger in the EBRT group. Thus, the results additionally suggested the need for further studies regarding the influence of age and ADT on general HRQOL and functional outcomes in patients after interventions for prostate cancer. ^[3]

The present study also showed that biochemical recurrence/progression was not associated with general HRQOL or functional outcomes in any group or risk category. Although all our patients showing biochemical recurrence were informed about their unfavorable disease condition, biochemical recurrence/progression was thought to have little impact on general HRQOL or functional outcomes. This is interesting when considering different risk estimated at diagnosis and actually different HRQOL/functional results in each risk group. It has been suggested that the posttreatment HRQOL score surveyed using questionnaires possibly appear better in patients without disease recurrence, simply because they are happy without disease. ^[4] Yet, our study employing definite risk stratification showed that biochemical progression does not have an influence on the HRQOL score reported with self-rating questionnaires. Thus, a longitudinal large study is warranted for the influence of biochemical recurrence on general HRQOL and functional outcomes as well as those evaluated according to risk stratification in patients with prostate cancer, who are managed with various approaches.

References

^[1] Giberti C, Chiono L, Gallo F, Schenone M, Gastaldi E. Radical retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol. 2009 May 20. [Epub ahead of print]
^[2] Takizawa I, Hara N, Nishiyama T, Kaneko M, Hoshii T, Tsuchida E, Takahashi K. Oncological results, functional outcomes and health-related quality-of-life in men who received a radical prostatectomy or external beam radiation therapy for localized prostate cancer: a study on long-term patient outcome with risk stratification. Asian J Androl. 2009;11(3):283-90.
^[3] Kang SH, Kim JW, Bae JH, Park HS, Moon DG, et al. Targeted-cryosurgical ablation of the prostate with androgen deprivation therapy: quality of life in high-risk prostate cancer patients. Asian J Androl 2006; 8: 629-36.
^[4] Ames SC, Tan WW, Ames GE, Stone RL, Rizzo TD Jr, Heckman MG, Crook JE, Clark MM, Rummans TA, Werch CE. Quality of life of men with biochemical recurrence of prostate cancer. J Psychosoc Oncol. 2008;26:17-34.

Written by Noboru Hara, MD, PhD as part of Beyond the Abstract on UroToday.com

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