PTU - Polskie Towarzystwo Urologiczne
list of articles:

Quality of life after radical prostatectomy
Article published in Urologia Polska 2005/58/1.

authors

Bartłomiej Gliniewicz, Andrzej Sikorski
Katedra i Klinika Urologii Pomorskiej Akademii Medycznej w Szczecinie
Kierownik kliniki: prof. dr hab. Andrzej Sikorski

keywords

prostate, prostate cancer, radical prostatectomy, post-prostatectomy quality of life

summary

introduction
The interest in the problem of quality of life has been increasing recently, also in the group of patients with prostate cancer (PCa). Survival time is no longer the only factor determining the choice of treatment modality. A potential candidate for radical prostatectomy (RP) faces the risk of complications such as urinary incontinence and severe erectile dysfunction, which influence significantly the physical and social functioning of the individual.
aim of the study
To assess changes in the quality of life of patients with PCa clinically confined to the prostate, treated with RP.
material and method
Pre-and post-operative quality of life 12 months after the surgery was assessed in 31 consecutive patients treated with retropubic RP method, receiving no neoadjuvant or adjuvant treatment. In each case, health-related quality of life (HRQL) - general and PCa-specific - was evaluated. Polish versions of SF-36 and UCLA-PCI questionnaires were used in the study. Including evaluation of pre-operative quality of life allowed to treat the studied patients as controls for themselves.
results
On the average, for all general HRQL scales of the SF-36 questionnaire, 72% of the patients returned to pre-RP condition. Statistically significant differences in scores were found for the scales of the UCLA-PCI questionnaire concerning the function of the urinary tract and sexual activity. For all PCI scales, the average of over 65% of the patients returned to pre-RP condition.
conclusion
RP does not exert a significant effect on the general HRQL - 12 months after the surgery, most patients report high levels of HRQL, comparable with pre-operative ones. Significant post-operative disturbances are reported with respect to the function of the urinary tract and sexual life. Considering the results of post-RP quality of life studies in talks with the patient awaiting treatment should help both patients and clinicians to assess more rationally the chances for cure and expected time to complete recovery.

references

  1. Huland H: Radical prostatectomy: options and issues. Eur Urol 2001; 39: 3-9.
  2. Eastham JA, Scardino PT: Radical prostatectomy. In Walsh PC, Retik AB, Vaughan ED Jr, Wein A eds, Campbell´s Urology, 8th edn, Philadelphia: Saunders, 2002; Vol. IV, Chapt 89, pp 3083-3088.
  3. de Walden-Gałuszko K: Ocena jakości życia uwarunkowana stanem zdrowia; w Meyza J (red): Jakość życia w chorobie nowotworowej, Warszawa, Centrum Onkologii - Instytut, 1997, wyd. I, str. 77-82.
  4. Litwin MS, Melmed GY, Nakazon T: Life after radical prostatectomy: a longitudinal study. J Urol 2001; 166: 587-592.
  5. Talcott JA, Litwin MS: Quality of life in prostate cancer. In Kantoff PW, Carroll PR, D`Amico AV eds, Prostate cancer: principles and practice, ed 1, Philadelphia, Lippincott Williams & Wilkins, 2002, Chapt 25, pp. 368-381
  6. Barry MJ, Litwin MS, Aaronson NK et al: Quality of Life. In Murphy G, Khoury S, Partin A, Denis L eds. Prostate cancer - 2nd international consultation on prostate cancer - June 27-29, Paris, Plymbridge Distributors Ltd., 1999, Chapt 13, pp. 451-479.
  7. Moinpour CM, Feigl P, Metch B et al: Quality of life end points in cancer clinical trials: review and recommendations. J Natl Cancer Inst 1989; 81: 485-495.
  8. Ware JE, Jr, Sherbourne CD: The MOS 36-item Short Form Health Survey (SF-36): Conceptual framework and item selection. Med Care 1992; 30: 473-483.
  9. Litwin MS, Hays RD, Finf A, et al: The UCLA Prostate Cancer Index: development, reliability and validity of a health-related quality of life measure. Med Care 1998; 36: 1002-1012.
  10. Lubeck DP, Litwin MS, Henning JM et al: Measurement of health-related quality of life in men with prostate cancer: the CAPSURE database. Qual Life Res 1997; 6: 385-389.
  11. Jaeschke R, Singer J, Guyatt GH: Measurement of health status. Ascertaining the minimal clinically important difference. Contr Clin Trials 1989; 10: 407-412.
  12. Juniper EF, Guyatt GH, Willan A: Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47: 81-86.
  13. Madalinska JB, Essink-Bot ML, de Koning HJ et al: Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol 2001; 19: 1619-1628.
  14. Penson DF, Litwin MS, Aaronson NK: Health related quality of life in men with prostate cancer. J Urol 2003; 169: 1653-1661.
  15. Arai Y, Okubo K, Aoki Y et al: Patient-reported quality of life after radical prostatectomy for prostate cancer. Int J Urol 1999; 6: 78-86.
  16. Lubeck DP, Litwin MS, Henning JM et al: Changes in health-related quality of life in the first year after treatment for prostate cancer: results from CaPSURE. Urology 1999; 53: 180-186.
  17. Altwein J, Ekman P, Barry M et al: How is quality of life in prostate cancer patients influenced by modern treatment? The Wallenberg symposium. Urology 1997; 49: 66-76
  18. Litwin MS, Lubeck DP, Henning JM et al: Differences in urologist and patient assessment of health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol 1998; 159: 1988-1992.
  19. Fossĺ S, Wćhre H, Kurth KH et al: Influence of urological morbidity on quality of life in patients with prostate cancer. Eur Urol 1997; 31: 3-8.
  20. Fowler FL, Barry MJ, Lu-Yao G: Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990. Urology 1993; 42: 622-629.
  21. Stanford JL, Feng Z, Hamilton AS: Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer. The Prostate Cancer Outcomes Study. JAMA 2000; 283: 354-360.
  22. Walsh PC: Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol 2000; 163: 1802-1807.
  23. Bacon CG, Giovannucci E, Testa M, Kawachi I: The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. J Urol 2001; 166: 1804-1810.
  24. Davis JW, Kuban DA, Lynch DF, Schellhammer PF: Quality of life after treatment for localized prostate cancer: differences based on treatment modality. J Urol 2001; 166: 947-952.
  25. Litwin MS: Health related quality of life in older men without prostate cancer. J Urol 1999; 161: 1180-1184.

correspondence

Bartłomiej Gliniewicz
Katedra i Klinika Urologii PAM
Al. Powstańców Wielkopolskich 72
70-111 Szczecin
tel./fax: (0...91) 466 11 00
bartekmd@wp.pl