Prostate cancer treatment and quality of life in the “real world”


The idea that most men will recover meaningful erectile and sexual function after treatment for prostate cancer has long been disputed by many in the patient community. We now seem to have some better data supporting the patient perspective.

According to a presentation by Deschamps at the European Association of Urology 2020 virtual congress, reported on by Renal and Urology News, the so-called EUPROMS study, which surveyed nearly 3,000 prostate cancer patients in Europe, has suggested that, for about 50 percent of these patients, loss of sexual function (including the ability to have an erection or reach orgasm) was a “big”  or “moderate” problem.

EUPROMS (the Europa Uomo Patient Reported Outcomes Study) enrolled 2,943 European men from 25 different countries. The patients all responded to an online survey of three standard questionnaires used to assess the effects of prostate cancer treatment:

  • The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire
  • The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC-QLQ-C30)
  • The EuroQol Group Health Questionnaire (EQ-5D-5L)

Here are some of the core survey findings:

  • The average (mean) age of the patients surveyed was 70 years.
  • The average (mean) age of the patients at diagnosis was 64 years.
  • 82 percent of the patients were living with a partner at the time of the survey
  • Two-thirds of patients underwent at least one form of prostate cancer “treatment” (inclusive of active surveillance).
  • 22, 10, and 2 percent had two, three, or four or more treatments, respectively.
  • Patients reported that loss of sexual function was
    • A “big” problem in 28 percent of cases
    • A “moderate” problem in 22 percent of cases
  • Chemotherapy, radiation therapy (RT), and radical prostatectomy (RP) were each increasingly associated with severe loss of sexual function (scores 12 vs 17 vs 21, respectively, on the EPIC-26 questionnaire).

Deschamps further reported that:

  • Respondents scored their sexual function much lower than patients in clinical studies.
  • Active surveillance was associated with better sexual function and RP and RT with worse sexual function among survey respondents than patients in clinical trials.
  • Levels of urinary incontinence was highest in men managed with RP.
  • Compared with RP, fatigue scores were
    • Twice as high among men treated with RT radiation therapy (score 22 vs 11 on the EORTC-QLQ-C30)
    • Three times as high among men treated with chemotherapy (score 33 vs 11 on the EORTC-QLQ-C30)
  • Chemotherapy was associated with the lowest overall health-related quality of life (QoL) scores.
  • Self-reported QoL scores are best when prostate cancer is discovered in an early, potentially curable stage.

Deschamps also clearly states that:

Quality of life is negatively impacted by any treatment of prostate cancer other than active surveillance. Hence, active surveillance should be promoted as the first option for treatment for those men [for whom] it can be offered safely.

 

7 Responses

  1. If I could have a do-over I would do nothing.

  2. I have had Gleason 4 + 5 = 9 contained prostate cancer for 12 years (now age 82). I had a radical prostatectomy, with recurrence after 3 years; then ADT and 28 courses of radiation. This was followed by bladder cancer, now in remission. Sexual function never returned in a meaningful way.

    Between all that incontinence went from bad to having to wear “pull ups” like one of my granddaughters without the cute little duckies. My wife, a physician, responds to my despondency about all this by saying, “You’re alive”. She’s right as she usually is.

    I am in an extended, open-label clinical trial of olaparib (Lynparza) at Johns Hopkins, which has been remarkable. It is especially effective in those with BRCA1 or BRCA2 germline defect that I am also “blessed” with. … In this case a counterintuitive “blessing”. I should have been dead long ago but my PSA is down to 0.14 ng/ml and other than the normal aches of 82 I feel perfectly fine. The impotence and incontinence is something I have to keep in perspective.

  3. “has long been disputed”

    Not just long been “disputed” but long been known to be false. And largely as a consequence of one of the biggest medical scams of modern times, PSA screening, that is justified using an invalid statistical inference from lumping together several inconsistent trials. A truly appalling example of vested interests (urologists) putting themselves ahead of the people they are supposed to be caring for.

  4. Misleading headline – this is about men in their 70s and active surveillance. I remain very satisfied I had my prostate removed and additional treatments.

  5. Dear Mr. Wadsworth:

    This headline is NOT misleading. The patients surveyed included men on active surveillance (a form of “management” as opposed to a form of “treatment”) but also included numerous men who were very definitively treated with surgery, with radiation therapy, and even with chemotherapy. Your individual response to your treatments over time does not necessarily correspond to the effects of treatments on other men.

  6. Testing and treatment was one of the worst mistakes I have ever made in my life. My doctor lied to me and I now have a long list of side effects. I get no help from any of my doctors.

  7. I too wish that I had never been treated. The side effects (incontinence, impotence) are far more devastating than the disease.

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