Early quality of life in patients with localized prostate carcinoma: an examination of treatment-related, demographic, and psychosocial factors

Abstract

Background: Men with localized prostate carcinoma are faced with important treatment decisions, and quality of life (QoL) information has become a crucial element of decision making. The first objective of this study was to compare the early, health-related QoL (HRQoL) of men with localized prostate carcinoma who were treated with radical prostatectomy, external beam radiotherapy, or brachytherapy. A second objective was to identify demographic and psychosocial variables that predict HRQoL.

Methods: Two-hundred fifty-six men with localized prostate carcinoma were interviewed within 7 weeks of treatment initiation. The interview included measures of prostate-specific HRQoL (the University of California-Los Angeles Prostate Cancer Index), general HRQoL (the SF-36), and psychosocial variables.

Results: After adjusting for covariates, treatment group differences were found for both prostate specific HRQoL and general HRQoL. Men who underwent prostatectomy reported more urinary and sexual problems and more general physical dysfunction compared with men who were treated with either form of radiation therapy. Men who were treated with brachytherapy reported the fewest problems in sexual function and the least general physical dysfunction. Few treatment group differences were found in mental functioning. Both demographic factors and psychosocial factors predicted HRQoL. Older men and African-American men reported more physical problems than younger men and Caucasian men, respectively. A supportive social environment, high self-efficacy, and high self-esteem were predictive of better HRQoL.

Conclusions: Shortly after undergoing treatment for localized prostate carcinoma, men who underwent radical prostatectomy, older men, and African-American men are at heightened risk for experiencing prostate-specific and general deficits in HRQoL. Having psychosocial resources from which to draw may enhance HRQoL.

FIGURE 1

Profiles of general health-related quality of life (HRQoL) by treatment. Note that the treatment group means were adjusted for age or comorbid conditions when appropriate. EBR: external beam radiotherapy; BT: brachytherapy; RP: radical prostatectomy; PCS: physical component summary score; MCS: mental component summary score; PF: physical function; RF: role-physical function; BP: bodily pain; GH: general health; VT: vitality/energy level; SF: social function; RE: role-emotional function; MH: mental health. Higher scores mean better HRQoL.