The Impact of Prostate Cancer Treatment on Quality of Life: A Narrative Review with a Focus on Randomized Data

Abstract

Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best made in an informed and shared medical decision-making process between clinician and patient with respect to cancer control as well as adverse effects. We outline in this narrative review an understanding regarding implications of surgical and radiation treatment on quality of life after treatment, and how these data may be considered in the context of advising patients regarding the selection of therapy. This narrative review largely focuses on the quality of life data obtained from prospective randomized trials of men treated for prostate cancer. We believe this provides the best assessment of the quality of life and can be used to inform patients when making treatment decisions.

Keywords: prostate cancer; quality of life; radiation therapy; radical prostatectomy; toxicity.

Figure 1

Surgical and Radiotherapeutic Approaches in the Treatment of Prostate Cancer. (A) pre- and post-prostatectomy anatomy with retropubic and perineal surgical approaches. (B) microsurgical anatomy at risk for injury with retropubic and surgical approaches. (C) clinical target volumes (CTV) for radiotherapy for intact prostate treated definitively with external beam radiotherapy (XRT). When indicated pelvic lymph node fields are added, increasing the potential for gastrointestinal toxicity. (D) CTV for radiotherapy for prostate fossa treated adjuvantly or in salvage cases. The utility of lymph node coverage in this setting is the subject of clinical investigation. (E) CTV for low-dose-rate brachytherapy with or without XRT treatment. High-dose-rate techniques are available using temporary catheter-based placement of an Ir-192 source with established fractionation schedules and fewer post-treatment radiation precautions.