Health-related quality-of-life effects of watchful waiting re-evaluated in SPCG-4

Abstract

This commentary discusses the re-analysis of the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), which had previously shown a modest but significant survival benefit of prostatectomy over watchful waiting. In the re-analysis, patients allocated to watchful waiting experienced a significantly decreased health-related quality of life (HRQOL) at 6-8 years after randomization, compared with those who underwent radical prostatectomy. HRQOL differences between treatment arms in the first 5 years after randomization were limited to worse erectile dysfunction among patients randomized to prostatectomy. These findings indicate that watchful waiting might be associated with greater late deterioration in select domains of HRQOL than is prostatectomy. In addition, patients randomized to watchful waiting who received androgen deprivation therapy (ADT) reported a lower sense of well-being, more-depressed mood, and a lower self-assessed quality of life compared with those who did not receive ADT, which indicates that ADT might adversely affect HRQOL in this patient population.