Health-related quality of life in long-term prostate cancer survivors after nerve-sparing and non-nerve-sparing radical prostatectomy-Results from the multiregional PROCAS study

Abstract

Background: Nerve-sparing (NS) surgery was developed to improve postoperative sexual and potentially urological outcomes after radical prostatectomy (RP). However, it is largely unknown how NSRP affects health-related quality of life (HRQoL) including urinary and sexual outcomes in prostate cancer (PC) survivors 5-10 years after diagnosis in comparison with Non-NSRP.

Methods: The study population included 382 stage pT2-T3N0M0 PC survivors 5-10 years post diagnosis, who were identified from the multiregional Prostate Cancer Survivorship in Switzerland (PROCAS) study. Briefly, in 2017/2018, PC survivors were identified via six population-based cancer registries based in both German- and French-speaking Switzerland. HRQoL and PC-specific symptom burden was assessed using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Differences in HRQoL outcomes between survivors treated with NSRP (uni- & bilateral) and Non-NSRP were analyzed with multivariable linear regression adjusted for age, years since diagnosis, cancer stage, comorbidities at diagnosis, and further therapies, if appropriate. Multiple imputation was performed to minimize the bias due to missing data.

Results: Five to ten years after diagnosis, PC survivors treated with NSRP and Non-NSRP reported similar symptom burden and comparable HRQoL function scores. The only significant differences were reported for sexual activity, whereas PC survivors who underwent NSRP reported statistically significant (P = .031) higher sexual activity than those on Non-NSRP. NSRP and Non-NSRP reported similar scores for urinary symptoms and all other HRQoL outcomes.

Conclusions: Our results support nerve-sparing techniques as an option to improve postoperative sexual, but not urinary outcomes after RP in long-term PC survivors.

Keywords: health-related quality of life; long-term survivor; nerve-sparing radical prostatectomy; prostate cancer; sexual outcomes; urinary outcomes.

Figure 1

Study Flowchart. *For PC survivors in the cantons of Basel‐Stadt (BS), Basel‐Landschaft (BL), and Fribourg (FR) information on degree of NSRP was not available

Figure 2

Adjusted mean scores of EORTC QLQ‐C30 HRQoL scales of PC survivors by nerve‐sparing status (after multiple imputation of missing values). A high score represents a high/healthy level of functioning/high QoL. Mean scores were adjusted for age at survey, years since diagnosis, cancer stage, comorbidities at diagnosis, and further therapy if appropriate. I bars represent ± standard errors; all P‐values > .05

Figure 3

Adjusted mean of EORTC QLQ‐C30 symptom scales of PC survivors by nerve‐sparing status (after multiple imputation of missing values). A high score represents a high symptom burden. Mean scores were adjusted for age at survey, years since diagnosis, cancer stage, comorbidities at diagnosis, and further therapy if appropriate. I bars represent ± standard errors; all P‐values > .05

Figure 4

Adjusted mean of EORTC PR25 scales of PC survivors by nerve‐sparing status (after multiple imputation of missing values).A high score represents higher symptom burden or higher sexual activity/ better sexual functioning. Mean scores were adjusted for age at survey, years since diagnosis, cancer stage, comorbidities at diagnosis and further therapy if appropriate.¹ smaller sample size as questions regarding these functions were conditional—urinary bother (n = 104) & sexual functioning (n = 183)I bars represent ± standard errors; all P‐values > .05 if not indicated otherwise