Quality of life 12 to 32 months post-treatment among men in Norway

A recently reported study offers us data from a cohort of nearly 800 men in Norway, all diagnosed in 2004 with localized or locally advanced prostate cancer and then surveyed for quality of life in October 2006.

This study may tell us more about the quality of life after treatment in Norway than it does about quality of life post-treatment in other countries, but it is still of considerable interest because it is one of very few attempts to obtain good data on quality of life post-diagnosis and treatment across an entire nation (as opposed to from a specific institution).

Kyrdalen et al. set out to do three things:

  • Gain accurate estimates of typical, population-based adverse effects (AEs) to treatment — or no treatment — among men with localized or locally advanced (but non-metastatic), recurrence-free prostate cancer
  • Describe associations between typical AEs and global quality of life (QOL)
  • Study patients’ use of medications for erectile dysfunction (ED) and their effects of such medications on global QOL.

The survey was based on data collected using a postal survey mailed to a national, population-based sample of prostate cancer survivors in October 2006. All men surveyed had been initially diagnosed in 2004 and had completed their initial treatment. The use of a national prescription database allowed the research team to gain accurate information on the application of adjuvant hormone therapy and medicines for treatment of ED.

The researchers classified responders into one of four “treatment” categories:

  • Men who received no treatment (i.e., they were simply monitored in some way) (Group A)
  • Men treated by first-line radical prostatectomy (RP) (Group B)
  • Men treated by first-line radiation therapy without hormone therapy (Group C)
  • Men treated by first-line radiation therapy with hormone therapy for 3-24 months (Group D)

Here are the core findings of the study:

  • 771 men who met the study criteria returned completed survey forms.
  • Men in Group B reported more urinary incontinence (24 percent) than men in the other three treatment groups.
  • Men in Group B had the lowest level of moderate/severe irritative-obstructive urinary symptoms.
  • Men in Group A had the highest level of moderate/severe irritative-obstructive urinary symptoms.
  • Men in Groups C and D reported higher levels of irritative intestinal symptoms and fecal leakage than men in Groups A and B.
  • Poor sexual drive and poor erectile function were common AEs in all groups, but men in Group B reported the highest prevalence of poor erectile function (at 89 percent).
  • Reports of irritative-obstructive urinary symptoms and poor sexual drive were independently associated with low global QOL.
  • 50 percent of the entire study group had used medication for ED after the start of their treatment start.
    • 47 percent of these men were still using medication for ED at the time of the survey.
    • Use of medication for ED was not significantly associated with global QOL.

The authors conclude that, in this Norwegian study population:

  • Prostate cancer survivors initially diagnosed with localized or locally advanced disease have high levels of urinary and sexual AEs at 12 to 32 months of follow-up — after curative treatment or after simple monitoring.
  • Irritative-obstructive urinary symptoms and poor sexual drive were significantly associated with low global QOL.
  • Erectile function and use of medication for ED were not associated with low global QOL.

The results of this study are not exactly surprising. Although this information is not provided in the abstract, it would be reasonable to assume that the average age of the patients at the time of competion of the survey was probably nearer to 70 years than 65 years, and so a relatively low level of sexual drive and a high level of ED would be quite normal in such a population.

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