Search

Importance: The association between radiotherapy (RT) timing after radical prostatectomy and long-term patient-reported health-related quality of life (HRQOL) in men with prostate cancer is unknown., Objective: To measure long-term HRQOL in men with prostate cancer up to 15 years after prostatectomy with or without RT and examine whether early vs late postprostatectomy RT is associated with differences in sexual, urinary, and bowel HRQOL., Design, Setting, and Participants: A prospective, multicenter, longitudinal cohort analysis using HRQOL data from the PROST-QA (2003-2006) and RP2 consortium (2010-2013) studies was conducted. Men with localized prostate cancer undergoing radical prostatectomy were included. Data were analyzed between May 8, 2023, and March 1, 2024. The study was conducted in 12 high-volume academic medical centers in the US., Exposures: Men were stratified based on receipt and timing of postprostatectomy RT: prostatectomy only, early RT (<12 months), and late RT (≥12 months)., Main Outcomes and Measures: Longitudinal sexual, incontinence, urinary irritation, bowel, and hormonal/vitality HRQOL were measured via the Expanded Prostate Cancer Index Composite at baseline; months 2, 6, and 12; and annually thereafter. Treatment groups were compared using multivariable linear mixed-effects models of change in longitudinal domain scores. Pad use for incontinence was measured longitudinally among men receiving postprostatectomy RT., Results: A total of 1203 men were included in the study: prostatectomy only (n = 1082), early RT (n = 57), and late RT (n = 64). Median age for the entire cohort was 60.5 (range, 38.8-79.7) years, and 1075 men (92.0%) were White. Median follow-up was 85.6 (IQR, 35.8-117.2) months. Compared with men receiving prostatectomy alone, those receiving postprostatectomy RT had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL. However, timing of postprostatectomy RT, specifically early vs late, was not associated with a long-term decrease in any HRQOL domain. There was evidence of improved recovery of sexual, continence, and urinary irritation scores among men receiving early RT compared with those receiving late RT after prostatectomy. Before the start of postprostatectomy RT, 39.3% of men in the early RT cohort and 73.4% of men in the late RT cohort were pad-free. By the sixth visit post-RT, 67.4% in the early RT cohort and 47.6% in the late RT cohort were pad-free., Conclusions and Relevance: In this multicenter, prospective analysis, postprostatectomy RT appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy RT may result in similar long-term HRQOL outcomes.

Purpose: Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study., Materials and Methods: We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications., Results: Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain., Conclusions: In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.

Objective: To classify the Expanded Prostate Cancer Index Composite (EPIC)-Short Form urinary domain (EPIC-UIN) scores, as part of a validated health-related quality of life instrument after prostate cancer treatment into clinically meaningful functional categories., Materials and Methods: Using a prospectively maintained database, approved by the institutional review board, of patients undergoing prostatectomy for malignancy, the patient and tumor factors and validated health-related quality of life instruments, including EPIC-UIN and the Incontinence Severity Index (ISI) were retrospectively reviewed. The questionnaires were completed preoperatively, at 3, 6, 9, and 12 months postoperatively, and yearly thereafter. Cutpoints were chosen for the EPIC-UIN scores to correlate with ISI, and statistical analysis querying this correlation was performed., Results: A total of 446 patients completing 764 questionnaires were reviewed. On average, the patients were 59.2 years old with a Gleason score of 6.75. All patients underwent robotic-assisted (n=224) or radical retropubic (n=222) prostatectomy. The range of ISI scores at the prescribed measurement points was "mild" (0-6), "moderate" (7-16), and "severe" (≥17) in 58.9%, 28.9%, and 11.3% of patients, respectively. An EPIC-UIN score of 0-49, 50-69, and 70-100 was chosen to correlate with the ISI score of "severe," "moderate," and "mild," with an agreement of 74.1% (weighted kappa coefficient 0.6541). Severe incontinence and moderate incontinence on the EPIC-UIN were associated with a sensitivity of 74% and 90.6% and specificity of 90.2% and 93.6%, respectively., Conclusion: Categorical EPIC-UIN groups were developed to represent the mild, moderate, and severe incontinence. These categories provided meaningful guides for assessing postoperative urinary incontinence and recovery of urinary function., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To document the Expanded Prostate cancer Index Composite (EPIC) results for men followed for 5 years after radical prostatectomy., Patients and Methods: EPIC and demographic information were prospectively obtained from 434 patients who received questionnaires preoperatively and 1, 4, 12, 24, 36, 48 and 60 months postoperatively. Paired t-tests compared scores at individual time points. Percentage return to baseline was calculated at all postoperative time points and multivariate analyses evaluated postoperative trends., Results: The mean age of patients was 63.4 years. Mean urinary function and incontinence worsen after prostatectomy, with recovery stable 12 months after surgery. Mean urinary bother returned to baseline by 4 months post-prostatectomy. Some 55.8% and 77.5% of patients return to their urinary function and bother baselines, respectively, 1 year after surgery. Mean sexual function and bother both declined after surgery, with new stable baselines achieved by 24 and 36 months post-prostatectomy, respectively. Of the patients, 24.2% returned to their sexual function baseline by 24 months. No postoperative improvement was noted in mean sexual bother until the 12 months post-prostatectomy. Of the patients, 36.8% returned to their sexual bother baseline by 36 months. Minimal change was noted in the bowel and hormonal domains., Conclusions: Mean urinary function and incontinence did not recover to preoperative baseline after prostatectomy, although it did not add distress because mean urinary bother returned to pre-prostatectomy levels. Mean sexual function declined post-prostatectomy, with continued recovery up to 24 months. Sexual bother recovered later but, once it reached a new baseline, the distress does not lessen with time, probably indicating an inability to adjust to their functional loss., (© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL.)

Objectives: Preservation of periprostatic neurovascular tissue at the time of radical prostatectomy has been correlated with subsequent erectile function and urinary continence. We evaluated whether the amount of neurovascular tissue identified on prostatectomy specimens correlated with surgeon's intention of nerve-sparing and/or predicted quality of life outcomes., Materials and Methods: Radical prostatectomy specimens from 60 patients were evaluated by 2 pathologists for residual neurovascular bundle tissue. Reviewable pathology was available for 17, 19, and 19 patients with bilateral, unilateral, and non-nerve-sparing radical prostatectomy, respectively. The patients completed the Expanded Prostate Cancer Index Composite, a validated quality of life questionnaire. Differences between neurovascular tissue thickness, surgeon's intent at nerve-sparing, and quality of life among patients in each group were analyzed using standard statistical software., Results: Neurovascular tissue thickness identified on radical prostatectomy specimens did not correlate with surgeon's intent at performing a nerve-sparing procedure, nor was it found to be predictive of postoperative quality of life. Surgeon's intent at neurovascular preservation, however, was associated with improved sexual and urinary function scores at 1 year (both P < 0.05)., Conclusions: Surgeon intent, regardless of the amount of neurovascular tissue identified on radical prostatectomy specimen, is predictive of postoperative sexual-related and urinary quality of life. This suggests that factors other than the amount of neurovascular tissue spared contribute to postoperative sexual and urinary function., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Purpose: Patients undergoing radical cystectomy with neobladder for bladder cancer are hypothesized to tolerate worse urinary function than ileal conduit patients because of improved body image. The purpose of this study was to compare body image and quality of life between the 2 diversion types after surgery., Materials and Methods: Patients who underwent radical cystectomy at the University of Michigan from November 1999 onwards and completed follow-up between July 2007 and August 2008 were eligible for the study. Patients who had cystoscopy for bladder cancer were enrolled as a reference group. Urinary, bowel, and sexual outcomes were assessed using the Bladder Cancer Index, and body image was evaluated using the EORTC Body Image Scale. Cross-sectional analysis at baseline, 1 month, 6 months, and 1, 2, 4, 6, and 8 years after treatment was performed., Results: A total of 139 neobladder, 85 conduit, and 112 cystoscopy patients were studied. After cystectomy, both conduit and neobladder groups had worse body image scores that improved over time, although the neobladder group did not return to baseline. Age was associated with score but gender was not. Urinary function was better in conduit patients but urinary bother was the same in both diversion types., Conclusions: Radical cystectomy has a significant impact on body image that improves slowly over time. No difference in body image scores between ileal conduit and neobladder patients exists after surgery. Factors other than just body image are likely involved in the patient's acceptance of worse urinary function associated with a neobladder., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Purpose: We developed and validated a reliable, responsive multidimensional instrument to measure disease specific health related quality of life in bladder cancer survivors treated with local cancer therapy., Materials and Methods: Instrument content was based on qualitative information obtained from a panel of bladder cancer providers and from patient focus groups. Draft items were piloted and revised, resulting in the 36-item Bladder Cancer Index consisting of urinary, bowel and sexual health domains. Internal consistency, test-retest reliability, convergent validity, concurrent validity and criterion validity were then assessed., Results: Internal consistency was high at 0.77 to 0.91. Test-retest reliability was also high at 0.73 to 0.95. Correlations among the 3 domains were low (r < or = 0.39), indicating interscale independence. Health outcome discrimination was apparent in clinically distinct treatment groups. Moderate correlation was observed with existing external measures, indicating that the Bladder Cancer Index detects aspects of health related quality of life related to bladder cancer treatments that are not recorded by more general measures., Conclusions: The Bladder Cancer Index is a robust, multidimensional measure of bladder cancer specific health related quality of life and to our knowledge is the first available validated instrument to assess health outcomes across a range of local treatments commonly used for bladder cancer., (2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Evaluating quality of life outcomes following prostate cancer treatment is important because different treatments provide similar survival outcomes. A wide variety of quality of life surveys are used with an unknown correlation between domain specific and broad domain instruments. We compared the urinary and sexual outcome measures of the Expanded Prostate Cancer Index Composite, a broad domain instrument, to those of the Incontinence Symptom Index and the Sexual Health Inventory for Men, which are domain specific instruments., Materials and Methods: A total of 640 patients undergoing radical prostatectomy at our institution completed a combination of the Expanded Prostate Cancer Index Composite, Incontinence Symptom Index and Sexual Health Inventory for Men questionnaires. Matching functional domains were compared and correlation coefficients were calculated. Subgroup analysis was performed to compare specific information pertinent to recovery from prostatectomy., Results: Correlations between measures of incontinence were 0.26 to 0.84, while indicators of sexual function were 0.70 to 0.84. Subgroup analysis comparing measures of irritative symptoms demonstrated weaker correlations. Analysis in patients reporting no sexual activity also showed a significantly lower correlation of scores than that in patients reporting sexual activity., Conclusions: Expanded Prostate Cancer Index Composite scores generally demonstrate strong correlations with corresponding Incontinence Symptom Index and Sexual Health Inventory for Men scores, indicating similar measurements of information. Divergent correlations between irritative scores as well as scores in men who are not sexually active may indicate that the Expanded Prostate Cancer Index Composite has more descriptive validity in this population. Wider use of a single broad domain instrument such as the Expanded Prostate Cancer Index Composite to assess outcomes after prostate cancer treatment may improve clinical efficiency and allow comparative quality of life research across treatment types in the future.

Purpose of Review: The majority of men treated for localized prostate cancer are cured of their disease. As a result, it is important to discuss long-term quality of life (QoL) expectations when counseling patients regarding treatment options. The varying QoL outcomes for radical prostatectomy, external beam radiotherapy, brachytherapy, and cryotherapy will be reviewed., Recent Findings: Robotic and radical prostatectomy has similar outcomes with significant initial worsening of urinary continence and sexual function. External beam radiation has less impact on continence and sexual function but noteworthy bowel toxicity. Brachytherapy results in the most irritative urinary symptoms, with decreased sexual and bowel QoL as well. Cryotherapy greatly reduces sexual function., Summary: Every patient has unique pretreatment variables, priorities, and preferences. It is crucial to fully explain the range of oncologic and QoL implications when counseling patients regarding treatment for localized prostate cancer.

Purpose: To develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery., Method: Instrument content was based on qualitative data ascertained from focus groups of patients and input from an expert panel of clinicians and psychometricians. A draft questionnaire was then piloted and revised, leading to the 27-item Convalescence and Recovery Evaluation (CARE). CARE consists of four individually scored domains, which were identified using factor analysis. Test-retest reliability, internal consistency, and convergent validity were assessed., Results: Test-retest reliability was high, ranging from 0.78 for the activity domain to >0.88 for all others. Internal consistency varied over time postoperatively but was moderate to high for all domains throughout. Correlations between the four domains of CARE were low (each r

Objectives: To prospectively compare the relevant in-hospital and postdischarge short-term health outcomes in a contemporary group of patients undergoing either robotic or conventional radical prostatectomy., Methods: A total of 117 robotic and 89 conventional radical prostatectomy patients participated in a prospective study evaluating short-term postoperative recovery. A validated short-term health outcomes questionnaire was self-administered at 2 and 6 weeks postoperatively. All patients were given the same preoperative and postoperative instructions., Results: The significant differences in short-term health outcome measures between the two groups were that robotic patients had less mean narcotic use during the first 24 hours of admission (32 versus 52 mg morphine sulfate equivalents, P = 0.001) and a shorter mean length of hospital stay (1.2 versus 1.3 days, P = 0.048). No difference was found between the robotic and conventional radical prostatectomy groups regarding the median time to normal activity, 100% activity, and time to driving (9 and 8, 21 and 28, and 13 and 14 days, respectively). No difference was found in the postdischarge pain levels at 2 and 6 weeks, as reflected in the equivalent time of narcotic use between the two groups (10.6 and 9 days for the robotic and conventional radical prostatectomy groups, respectively)., Conclusions: The results of this prospective study have shown that both robotic and conventional radical prostatectomy provide comparable short-term postdischarge recovery, including time to normal and full activity, driving, and postdischarge narcotic use.

Background: Health-related quality of life (HRQOL) has not been adequately measured in bladder cancer. A recently developed reliable and disease-specific quality of life instrument (Bladder Cancer Index, BCI) was used to measure urinary, sexual, and bowel function and bother domains in patients with bladder cancer managed with several different interventions, including cystectomy and endoscopic-based procedures., Methods: Patients with bladder cancer were identified from a prospective bladder cancer outcomes database and contacted as part of an Institutional Review Board-approved study to assess treatment impact on HRQOL. HRQOL was measured using the BCI across stratified treatment groups. Bivariate and multivariable analyses adjusted for age, gender, income, education, relationship status, and follow-up time were performed to compare urinary, bowel, and sexual domains between treatment groups., Results: In all, 315 bladder cancer patients treated at the University of Michigan completed the BCI in 2004. Significant differences were seen in mean BCI function and bother scores between cystectomy and native bladder treatment groups. In addition, urinary function scores were significantly lower among cystectomy patients treated with continent neobladder compared with those treated with ileal conduit (all pairwise P<.05)., Conclusions: The BCI is responsive to functional and bother differences in patients with bladder cancer treated with different surgical approaches. Significant differences between therapy groups in each of the urinary, bowel, and sexual domains exist. Among patients treated with orthotopic continent urinary diversion, functional impairments related to urinary incontinence and lack of urinary control account for the low observed urinary function scores., (Copyright (c) 2007 American Cancer Society)

Background: It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urinary diversion in patients with advanced malignancy and to compare the results for different malignancies., Methods: One hundred three patients with advanced malignancies underwent palliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ninety-two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversion, and survival for patients with different malignancies were identified and compared. A modified Karnofsky performance scale (KPS) was used for assessment of physical performance. A scale of 0-4 was used: 0) hospitalized until death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal., Results: The mean age of patients was 68 years. The mean pre- and postoperative creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001). The median survival and days of hospitalization were 112 and 45, respectively. The median postdiversion KPS score was 2 (range, 0-4), and 15% of patients never left the hospital. Overall, 51% required secondary percutaneous procedures, and 68.4% had complications (minor, 63%; major, 5.4%)., Conclusions: Most patients with advanced cancers had poor performance status and survival after diversion. Eighty six percent had cancer-related symptoms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failure rate, and additional procedures were required.

Background and Objectives: As patients are being treated for prostate cancer at a younger age, a significant number of them will ultimately fail the primary treatment and will be candidates for potentially curative salvage therapy. The purpose of this study was to evaluate the impact of salvage therapy for locally recurrent prostate cancer upon the patients' quality of life., Methods: A cohort of 68 men with locally recurrent prostate cancer undergoing salvage treatment was included in this analysis. Data were collected for the study by mailing the subjects a self-administered questionnaire that included a General Functional Assessment of Cancer Therapy (FACT-G) and a Prostate Cancer Treatment Outcome Questionnaire (FACT-P). Group comparisons were conducted using one-way analysis of variance (ANOVA)., Results: Overall, 50% and 88.6% of patients were free of biochemical recurrence in the salvage surgery (SS) and salvage radiotherapy (SRt) group, respectively (P=0.4). The physical well-being (PWB) subscale of FACT-G was significantly higher for the SRt patients (P=0.008). Using the Trial Outcome Index Prostate subscale, the Trial Outcome Index Incontinence Urinary scores, and the Functional Assessment of Incontinence Therapy-Urinary score group comparisons, patients in the SRt group had a higher quality of life than patients in the SS group (P=0.038, P=0.001, and P=0.001, respectively)., Conclusions: In the current study, patients with clinically localized prostate cancer who are at high risk for local disease recurrence may have a trend toward better disease-free survival and a better urinary continence rates if the primary treatment is radical prostatectomy rather than radiation therapy.