Kaiser reports on quality of life outcomes after first-line treatment for prostate cancer

Kaiser Permanente maintains a large data registry in  order to assess the quality of outcomes over time among tens of thousands of Kaiser patients, prostate cancer patients included.

In the current study, by Chien et al., Kaiser used their prostate cancer database to assess the health-related quality of life (HRQoL) of men with prostate cancer at up to 24 months after treatment. The population included > 5,500 men newly diagnosed with prostate cancer between March 2011 and January 2014. All patients were asked to complete the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire prior to treatment, and then at 1, 3, 6, 12, 18, and 24 months after treatment through November 2014 for all methods of treatment.

Here is what the authors report:

  • The study included 5,727 newly diagnosed patients.
  • Evaluable data were collected from
    • 3,422 patients at diagnosis and prior to treatment
    • 2,329 patients at 1 month post-treatment
    • 2,017 patients at 3 months post-treatment
    • 1,922 patients at 6 months post-treatment
    • 1,772 patients at 12 months post-treatment
    • 1,260 patients at 18 months post-treatment
    • 837 patients at 24 months post-treatment
  • At 1 month post-treatment
    • Bowel scores were lowest for patients who had radiation therapy.
    • Irritative urinary symptoms were lowest for patients who had brachytherapy.
  • Sexual function declined after all forms of treatment, but
    • Patients receiving surgery showed the steepest declines.
    • Patients treated by open radical prostatectomy (ORP) had a greater decline in sexual function than those treated by robot-assisted laparoscopic prostatectomy (RALP).
    • Patients treated by RALP
      • Had better return of sexual function than those treated by ORP.
      • Had levels of sexual function at 24 months approaching those of patients treated by brachytherapy and radiation therapy
  • Urinary continence (UI) declined most in surgical patients.
    • Patients treated by RALP had slightly greater improvement in urinary continence at 12 to 24 months than patients treated by ORP.

The authors conclude that in this large, diverse set of patients, treated at a broad spectrum of centers, the patients’ health-related quality of life, post-treatment,

… varies by treatment method. Notably, sexual function recovers most for RALP patients. UI remains worse at 24 months after surgery, compared to other methods of prostate cancer treatment.

ow there is nothing too surprising here, But what this study does show, once again, is that full recovery of good sexual function and good continence post-surgery is not the norm. Patienst need to be fully advised of this as part of the discussion about surgical treatment for prostate cancer — and most particularly is they are interested in discussing surgical treatment for low-risk forms of prostate cancer, when the side effects of treatment may easily outweigh any benefits of that treatment — especially in men of > 65 years of age or a life expectancy of < 10 years.

6 Responses

  1. Once again, PCI provides an invaluable service. I read every email you send. I am continually astonished about how good, thorough, up to date, and easy to understand your reports are. It would be wonderful if every man contemplating treatment were to be aware of and read every email you send. I wish I had been aware of your site before I made my decision to have surgery.

  2. Reblogged this on littledeer74 and commented:

    As always, good information, easy to read. In my ideal world, every man dealing with prostate issues would be guided to this website.

  3. After a career as a KP doctor I was shocked that the program did not have a Center of Excellence or a registry when I was diagnosed 19 years ago. It is encouraging that they are using the data system for study. It is a captive population with a single-source record system.

    The program is large enough to have a few urologic oncologists, but there are none in this region.

  4. @Bill Martin: I am sorry to read your last sentence and of course agree with the rest. As an (adult) life-long depressive, I have been taught not to second-guess myself. Of course you have an alternative universe where you are a cross between the Colossus of Rhodes and a Pillar of Hercules, but there are others. And all treatments exact a cost. If it helps I have a choice to make, read this site daily, and am tilting towards surgery despite the fact that I would probably only have one nerve spared. An ageing prostate is a good thing to be rid of, not just for cancer control but (at least in my case) for obstructive symptoms which are going to get much worse after non-surgical treatment. And I don’t know how old you are but I can tell you from experience that at 59, pre-treatment, Old Father Time has words to say. Good luck and use all the resources available to you.

  5. Null, to click notification box. Sorry.

  6. Fixed. Another technoglitch.

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