Urologic Oncology: Seminars and Original Investigations
Original articleHealth-related quality of life after radical prostatectomy depends on patient׳s age but not on comorbidities
Introduction
Localized prostate cancer is characterized by the long time span from diagnosis to the development of cancer-related symptoms or death. This has led to advise curative therapy only for patients with a life expectancy of more than 10 years. The increasing life expectancy has subsequently resulted in curative treatment of prostate cancer in patients older than 70 years [1]. At the same time, these patients have experienced more comorbidities than younger patients have. Although there are sufficient data on quality of life (QoL) after prostatectomy in the general population, there are few data in patients older than 70 years or in patients with comorbidities. Previous publications on this topic have evaluated QoL in older patients without comparison with younger patients [2], evaluated QoL irrespective of treatment modality [3], [4], used retrospective data [5], or had low sample numbers [6]. Radical retropubic prostatectomy is the surgical standard treatment for 75% of patients in Germany (USA: 36%), whereas approximately 25% are treated with robot-assisted prostatectomy (USA: 64%) [7], [8]. We therefore designed this study to prospectively evaluate the following question: What is the influence of age and comorbidities on the course of health-related quality of life (HRQoL) before and after prostatectomy?
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Patients and methods
Patients with localized prostate cancer planned for radical retropubic prostatectomy were included in this prospective single-center study in Germany between December 2006 and September 2010. Patients treated with laparoscopic, robot-assisted prostatectomy were excluded from the analysis, as well as patients with prior prostate carcinoma–specific therapy (including neoadjuvant), and patients with insufficient knowledge of the German language. Assessment of comorbidities was performed by a
Results
Of 501 patients, 374 (75%) met the inclusion criteria. The median age at diagnosis was 66 years and ranged from 42 to 79 years; 25.1% of patients were younger than 60 years and 20.3% were older than 70 years. Overall, 63.4% of patients had no comorbidities (Charlson score = 0), 26.7% had 1 or 2 comorbidities, and 9.9% had severe comorbidities (Charlson score≥3). Demographics and cancer-specific clinical characteristics for the total study population and stratified by age at diagnosis are
Discussion
Altogether, QoL was very high in our study population. Clinically significant differences over time were found for emotional functioning and role functioning. Emotional functioning was very low preoperatively and increased over time. Role functioning was lowest 3 months postoperative and increased afterward almost to the preoperative level. All other functioning scores, global health score, symptom scales, and symptom items showed no clinically different scores in the course of evaluation.
In
Limitations
This study has some limitations that have to be considered. There likely is some form of selection bias. Only patients were included who came for prostatectomy to our hospital and were considered fit for surgery by their primary physician. These patients are likely to have a positive attitude toward the surgery and reconvalescence. Therefore, it might be that the absolute values of QoL are higher than in the general population. The comparisons between the groups should not be affected by this.
Conclusions
In our prospective evaluation, we compared HRQoL depending on age and comorbidities. Overall, HRQoL was stable after prostatectomy. We found that higher age and more severe comorbidities did not influence the HRQoL after radical prostatectomy compared with younger or healthier patients. To the contrary, older or comorbid patients appeared to have more often developed adapting mechanisms to illness. Symptom scores were very low in the whole study population. These findings should be taken into
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Cited by (3)
Identification and prediction of health-related quality of life trajectories after a prostate cancer diagnosis
2017, International Journal of Cancer
Results of this study were presented at the EAU 2013 in Milano and won the best poster of the session.
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These authors contributed equally to the work.