How different treatments for clinically localised prostate cancer affect quality of life

Lardas Michael, Christos Papachristou, Emmanouil Chrysafis, Andreas Skolarikos


Introduction: Patients with clinically localised prostate cancer
have a favourable long-term overall and cancer-specific survival
regardless of treatment choice. These options differ in terms of
side effects. Knowledge of the side effects of different management
options is crucial for making treatment decisions, as they
can negatively impact on patient’s quality of life.
Methods: We conducted a literature review for articles concerning
treatment and quality of life for clinically localised
prostate cancer to access the impact of different treatments
on patient’s quality of life.
Results: We identified 5 prospective randomised comparative
studies reporting QoL outcomes, recruiting a total of 2933
Conclusion: Surgery seems to produce sexual and urinary
incontinence deterioration, while external beam radiotherapy
can cause bowel dysfunction and bother. Men managed with
active surveillance have good overall quality of life scores, which
seem to be better than those of patients undergoing radical


Localised Prostate Cancer;Quality of life;Radical Prostatectomy; Radiotherapy;Active surveillance;Brachytherapy

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Arnold M, Karim-Kos HE, Coebergh JW, Byrnes G, Antilla A, Ferlay

J, et al. Recent trends in incidence of five common cancers in 26

European countries since 1988: Analysis of the European Cancer

Observatory. Eur J Cancer. 2015;51:1164-87.

Newcomer LM, Stanford JL, Blumenstein BA, Brawer MK. Temporal

trends in rates of prostate cancer: declining incidence of advanced

stage disease, 1974 to 1994. J Urol. 1997;158:1427-30.

N. Mottet JB, E. Briers, R.C.N. van den Bergh, M. Bolla, N.J. van

Casteren, P. Cornford, S. Culine, S. Joniau, T. Lam, M.D. Mason, V.

Matveev, H. van der Poel, T.H. van der Kwast, O. Rouvière, T. Wiegel.

Guidelines on Prostate Cancer. Accessed 12/07/16 at https://

Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P,

et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy

for Localized Prostate Cancer. N Engl J Med. 2016;375:1415-24.

Crook JM, Gomez-Iturriaga A, Wallace K, Ma C, Fung S, Alibhai S, et

al. Comparison of health-related quality of life 5 years after SPIRIT:

Surgical Prostatectomy Versus Interstitial Radiation Intervention

Trial. J Clin Oncol. 2011;29:362-8.

Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E,

et al. Patient-Reported Outcomes after Monitoring, Surgery, or

Radiotherapy for Prostate Cancer. N Engl J Med. 2016;375:1425-37.

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;27:607-12.

Johansson E, Steineck G, Holmberg L, Johansson J-E, Nyberg T,

Ruutu M, et al. Long-term quality-of-life outcomes after radical

prostatectomy or watchful waiting: the Scandinavian Prostate Cancer

Group-4 randomised trial. The Lancet Oncology. 2011;12:891-9.

Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al.

Radical prostatectomy versus observation for localized prostate

cancer. N Engl J Med. 2012;367:203-13.

Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development

and validation of the Expanded Prostate Cancer Index Composite

(EPIC) for comprehensive assessment of health-related quality of

life in men with prostate cancer. Urology. 2000;56:899–905.

Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA

Prostate Cancer Index: development, reliability, and validity of a

health-related quality of life measure. Med Care. 1998;36:1002-12.

Punnen S, Cowan JE, Chan JM, Carroll PR, Cooperberg MR. Longterm

health-related quality of life after primary treatment for

localized prostate cancer: results from the CaPSURE registry. Eur

Urol. 2015;68:600-8.

Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff

L, et al. Quality of life and satisfaction with outcome among

prostate-cancer survivors. N Engl J Med. 2008;358:1250-61.

Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson

RA, Penson DF, et al. Five-year outcomes after prostatectomy or

radiotherapy for prostate cancer: the prostate cancer outcomes

study. J Natl Cancer Inst. 2004;96:1358-67.

Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton

AS, et al. Long-term functional outcomes after treatment for

localized prostate cancer. N Engl J Med. 2013;368:436-45.

Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson

MD, et al. Association Between Radiation Therapy, Surgery, or

Observation for Localized Prostate Cancer and Patient-Reported

Outcomes After 3 Years. JAMA. 2017;317:1126-40.