Quality of life after treatment for localized prostate cancer: Differences based on treatment modality

Purpose: Brachytherapy with (103)palladium ((103) Pd) is an increasingly administered treatment modality for localized prostate cancer. We compared general and disease specific health related quality of life after Pd-103 treatment, radical prostatectomy and external beam radiation therapy given during the same time frame. Materials and Methods: We performed a retrospective cross-sectional survey study of patients treated at a single community medical center between 1995 and 1999. We mailed 5 validated health related quality of life survey instruments to 269, 142 and 222 men who underwent radical prostatectomy, Pd-103 treatment and external beam radiation therapy, respectively, with a response rate of greater than 80% in all groups. Results: General health related quality of life assessed by the SF-36 showed the same scores in patients who underwent prostatectomy and Pd-103 treatment. The University of California-Los Angeles Prostate Cancer Index was used to assess bowel, urinary and sexual function/bothersomeness. External beam radiation therapy reported was associated with worse bowel function and greater bowel bothersomeness. Prostatectomy was associated with worse urinary function compared to Pd-103 and external beam radiation therapy. Prostatectomy was associated with worse sexual function than Pd-103 or external beam radiation therapy, although nerve sparing surgery and erectile aids minimized the difference. American Urological Association symptom scores were initially higher for Pd-103 but became equal to those in the other groups in patients treated greater than 12 months from survey time. Disease-free men who underwent prostatectomy and Pd-103 brachytherapy were equally confident that cancer would not recur in the future. Satisfaction rates were equivalent and biochemical failure significantly decreased satisfaction in all groups. Conclusions: While general health related quality of life was mostly unaffected by the 3 most common treatments for prostate cancer, there were differences in bowel, urinary and sexual function. This information may aid patients in the decision making process.