Long-term quality of life for men on active surveillance

According to a paper presented today at the annual meeting of the European Association of Urology (EAU) in Munich, Germany, men on a structured active surveillance (AS) protocol have a high, long-term quality of life on follow-up.

Long-term quality of life data, i.e., quality of life data from 5- to 10-years of follow-up, are still rare among men  who elect AS as their first-line management option.

In a presentation given today by Venderbos et al. at the EAU meeting, the authors compared such long-term quality of life data from a set of 427 prostate cancer patients, all aged between 66 and 69  years of age at diagnosis. (See this media release from the EAU, which includes the abstract of the study presented.)

A total of 628 patients — all of whom had classically low-risk prostate cancer at diagnosis — were invited to participate in the study. They could all be categorized into one of three sets of patients:

  • Group A: Men who elected a highly structured AS strategy as their first-line management option
  • Group B: Men elected radical prostatectomy as their first-line management option
  • Group C: Men who elected radiation therapy as their first-line management option

A fourth group of men (Group D, n = 204) comprised a reference group of men of similar age and other characteristics who were free of prostate cancer.

All patients were followed for between 5 and 10 years, and were asked to complete a detailed, one-time-only questionnaire about their quality of life throughout the study period. (The fact that the questionnaire was completed just once throughout the study period does present a number of concerns about the quality of the data.)

Here is what Venderbos et al. have reported:

  • Follow-up for men in all three treatment groups prior to administration of the questionnaire was ≥ 4 years.
  • Response rates for completion of the study questionnaire were
    • 427/628 (68 percent) for all three groups of treated patients
    • 121/166 (73 percent) for the active surveillance group (Group A)
    • 74/111 (67 percent) for the radical prostatectomy group (Group B)
    • 232/348 (67 percent) for the radiation therapy group (Group C) and
    • 204/273 (75 percent) for the reference group (Group D).
  • Average (median) ages of the men in the four groups ranged from 73 to 76 years at time of administration of the study questionnaire
  • Compared to the men in Groups B and C, men in Group A were commonly
    • More highly educated
    • More likely to be still employed (probably related to their ages)
  • Compared to men in Groups B and C, men in Group A reported
    • A better average urinary function score of 100 for Group A vs. 83 in Group B (p ≤ 0.001)
    • A better average urinary continence score of 100 for Group A vs. 75 in Group B (p = 0.001)
    • A better sexual satisfaction score of 44 for Group A vs. 6 for Group B (p ≤ 0.001)
    • A better sexual satisfaction score of 44 for Group B vs. 18 for Group C (p = 0.001)
  • Anxiety levels were low for men who chose AS and were followed for a median of 6.5 years.
  • The quality of life of men on AS was very similar to that of men without prostate cancer (p > 0.05, i.e., no statistical difference).

Commenting on this study in the above-mentioned media release, Dr. Alberto Briganti (of Milan) stated:

This is an interesting study which corroborates the notion that active surveillance is not only safe but well accepted by patients as possible initial management of low risk prostate cancer.  … Proper patient counseling about safety of AS is key to maintain both good quality of life, and intact psychological and functional well-being over time. We also need to note that it is possible that patients choosing AS may be less disposed to accept any form of treatment, and this might be difficult to uncover via the retrospective comparisons of validated questionnaires.

One Response

  1. You mean men who get treated for prostate cancer have a lower quality of life vs. men that don’t. … I’m dumbfounded. … I never would have guessed. … Wow. … Amazing. … Who would have known. … I feel like an idiot not foreseeing this. ….

    I could have told the researches this for 1/20th of the money they spent on this study and they would have had my results in 30 seconds. …

    Once again the medical community astounds me on how they waste time and money on what every single person male/female knows about prostate cancer. What do these people think all the debate is about treatment or no treatment constantly. … I mean really, they thought this was a worth while study? … Why do I see some grad student needing to write a thesis to graduate and this was an easy out?

    I should have gone to medical school. … I could have slept through it ….

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