Aim: To assess treatment-related changes in Quality of life (QoL) up to 15-years post-diagnosis of localised prostate cancer (LPC).
Methods: Eligible men were aged less than 70 years, diagnosed with LPC between October 2000-October 2002, and recruited from the population-based NSW cancer registry in Australia into the NSW Prostate Cancer Care and Outcomes Study (PCOS). Age- and residence-matched controls were randomly recruited into PCOS from the NSW electoral roll. We assessed self-reported general health and disease specific QoL across seven time points over a 15-year period, using the SF12, UCLA-PCI, and EPIC26. Adjusted mean differences (AMDs) were calculated using controls as the comparison group. Clinical significance of AMDs was assessed by the minimally important difference (1/3 standard deviation from baseline scores).
Results: 1642 men with LPC and 495 population-based controls participated in PCOS. At 15 years, all treatment groups reported high levels of erectile dysfunction (73·3% to 94·4% depending on treatment, controls 50·0%). Men who had external beam radiation therapy and/or high-dose rate brachytherapy (EBRT/HDR) or androgen deprivation therapy (ADT) as primary treatment reported more bowel problems. Self-reported urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the ADT group from 10- to15-years (Year 10: AMD=-5·3, 95% CI [-10·8 to 0·2], Year 15: AMD= -15·9; 95% CI [-25·1 to -6·7]).
Conclusions: Each treatment approach was associated with adverse reports of long-term QoL in some degree. Survivors commonly reported chronic side-effects and functional survivorship issues (e.g. incontinence, bowel and/or sexual dysfunction) out to 15 years post-diagnosis. Assessing these longitudinal QoL trajectories strengthens the evidence base for informed decision-making, particularly as men often report treatment decisions to be confusing. These findings support the development and implementation of interventions aimed to improve value-based treatment decision-making for the early management of LPC.