Munich, Germany (UroToday.com) Dr. Johansson began her presentation with a quote from Alexis Carrel “The quality of life is more important than life itself.” The purpose of QOL analysis is to identify negative symptoms and their consequences in an individual, to find ways of prevention, and finally to improve treatment.
The QOL is measured either by psychometric questionnaires or by study-specific questionnaires. The psychometric questionnaires are validated questions that have been tested for validity and reliability and are comparable. The study-specific questionnaires are used to further explore symptoms and hypothesis within a study.
QOL analysis is very important for patients with localized prostate cancer because the life expectancy can be upwards of two decades or more, emphasizing the role of a long-term quality of life data. Risks of negative side-effects of an intervention must be balanced by any gain in survival by treatment.
Dr. Johansson then used SPCG-4 study to illustrate an importance of a QOL study. SPCG-4 study randomized 695 Scandinavian men with localized prostate cancer to radical prostatectomy or watchful waiting betweein 1989 and 1999. QOL was obtained at 4 and 12 years. The findings indicate that surgery does give a survival benefit as compared to watchful waiting. At 18 years, patients who underwent prostatectomy had cancer-specific mortality of 17.7% versus 28.7% in watchful waiting. The NNT was 8 patients. The survival benefit was clear in men < 65 years where more men died of prostate cancer rather than from other cause. In men > 65 years, more men died from other-cause mortality rather than from prostate cancer.
A QOL analysis of patients in SPCG-4 (both RP and WW arms) age-matched against a non-cancer control group revealed a prevalence of erectile dysfunction to be 84% in RP and 80% in WW compared to 46% in the control arm. Additionally, prevalence of urinary leakage was 41%, 11% and 3% in the RP, WW and non-cancer controls. Distress from ED and urinary leakage, however, is the highest in the RP group. These results indicate that functional outcomes can also be negatively affected by progression of untreated disease in WW. ED and urinary incontinence rates increase in WW group from 4 years post-diagnosis to 12 year post-diagnosis.
Overall at 12 years, comparing 4 arms (WW, WW+ADT, RP+ADT, and RP), WW resulted in the highest QoL while WW + ADT resulted in the lowest QoL. The RP group as opposed to WW groups reported receiving significantly more information about cancer, its treatments, and side effects.
Dr. Johansson concludes that minimizing negative perceived side-effects should remain a high priority in prostate cancer care. We need to avoid over-treatment. We also need to provide appropriate counseling to all patients on evolving side effects with time and aging. Patients who choose WW should also be counseled about need for further therapy and increased rates of ED or incontinence with time as cancer progresses.
Presented By:
E.M. Johansson, Uppsala (SE)
Reported By:
Mohammed Haseebuddin, MD, at the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany
Fox Chase Cancer Center