TY - JOUR
T1 - Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer
AU - Donovan, Jenny L.
AU - Hamdy, Freddie C.
AU - Lane, J. Athene
AU - Mason, Malcolm
AU - Metcalfe, Chris
AU - Walsh, Eleanor
AU - Blazeby, Jane M.
AU - Peters, Tim J.
AU - Holding, Peter
AU - Bonnington, Susan
AU - Lennon, Teresa
AU - Bradshaw, Lynne
AU - Cooper, Deborah
AU - Herbert, Phillipa
AU - Howson, Joanne
AU - Jones, Amanda
AU - Lyons, Norma
AU - Salter, Elizabeth
AU - Thompson, Pauline
AU - Tidball, Sarah
AU - Blaikie, Jan
AU - Gray, Catherine
AU - Bollina, Prasad
AU - Catto, James
AU - Doble, Andrew
AU - Doherty, Alan
AU - Gillatt, David
AU - Kockelbergh, Roger
AU - Kynaston, Howard
AU - Paul, Alan
AU - Powell, Philip
AU - Prescott, Stephen
AU - Rosario, Derek J.
AU - Rowe, Edward
AU - Davis, Michael
AU - Turner, Emma L.
AU - Martin, Richard M.
AU - Neal, David E.
PY - 2016/10/13
Y1 - 2016/10/13
N2 - BACKGROUND Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes. METHODS We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle. RESULTS The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life. CONCLUSIONS In this analysis of patient-reported outcomes after treatment for localized prostate cancer, patterns of severity, recovery, and decline in urinary, bowel, and sexual function and associated quality of life differed among the three groups.
AB - BACKGROUND Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes. METHODS We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle. RESULTS The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life. CONCLUSIONS In this analysis of patient-reported outcomes after treatment for localized prostate cancer, patterns of severity, recovery, and decline in urinary, bowel, and sexual function and associated quality of life differed among the three groups.
UR - http://www.scopus.com/inward/record.url?scp=84991265987&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1606221
DO - 10.1056/NEJMoa1606221
M3 - Article
C2 - 27626365
AN - SCOPUS:84991265987
SN - 0028-4793
VL - 375
SP - 1425
EP - 1437
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 15
ER -