A prospective cohort study indicates that all treatments for localised prostate cancer have a significant impact on quality of life, however the areas affected vary by treatment with androgen deprivation therapy resulting in poorest general physical and mental health.

The authors of this study note that survival after diagnosis of localised prostate cancer is now very good, with some countries reporting 100% five-year survival. As all the commonly used treatments have nearly equal survival rates, quality of life issues become important in choice. This study aimed to quantify the effects of treatments on a range of health and disease-specific functions. Participants were men aged under 70 who were diagnosed with localised prostate cancer in New South Wales (NSW), Australia, between October 2000 and October 2002 and notified to the NSW Cancer Registry. Controls were men matched for age and postal code who were selected from the NSW electoral roll. Treatments were active surveillance, radical prostatectomy, external beam radiotherapy, androgen deprivation therapy, low or high dose rate brachytherapy, or any combination of these. Those initially receiving  active surveillance but who had active treatment within six months of diagnosis were coded as having had active treatment. Primary outcomes were general health specific and disease specific function, according to the 12 item short form health survey and the University of California, Los Angeles prostate cancer index. Follow-up was up to three years after diagnosis.

There were 1,642 participating patients of 3,195 potentially eligible; main reasons for non-inclusion refusal of consent by patient or treating doctor (n=1,164). These were matched with 495 controls. The majority of patients (981, 60%) had radical prostatectomy, and most of the remainder had external beam radiotherapy, with or without androgen deprivation therapy (289/1636, 18%) or active surveillance (200/1636, 12%). Mean age at diagnosis was 61.2 years (range 37 to 69). The patient population was not heterogeneous, with significant differences in treatment allocation according to several demographic factors. Only 99 (6.6%) reported disease spread or recurrence at three years.

After adjustment for confounders, patients overall had similar general physical and mental health, although scores in those treated with androgen deprivation therapy were lower than others. Specific functional areas related to prostate cancer, however, showed significantly lower scores than controls. These included sexual function, which was lower than controls in all groups but particularly low for men on androgen deprivation therapy (adjusted odds ratio (OR) 0.02, 95% CI 0.01 to 0.07). Bowel function was affected in all groups, but poorest in cases who had external beam radiotherapy whether alone or in combination (adjusted OR 0.44, 95% CI 0.30 to 0.64). Effect on urinary function was greatest in those treated surgically (adjusted OR 0.17, 95% CI 0.13 to 0.22) and least in those receiving androgen deprivation therapy.

The authors conclude that in this sample of relatively young men diagnosed with localised prostate cancer, treatment had significant and persistent effects on quality of life. These tended to be most pronounced in men who underwent radical prostatectomy, external beam radiotherapy, or any treatment involving androgen deprivation, however only those who had primary androgen deprivation therapy had poorer general physical or mental quality of life than controls at three years. Many men had problems with urinary and bowel function, however the impact on sexual function was greatest. Men who had androgen deprivation therapy, in particular, were likely to report sexual problems.

The authors discuss the limitations of their study, but conclude that the results can probably be generalised to similar patients in other developed countries diagnosed in 2000. They comment that improvements in therapy since then may have improved outcomes; however they cannot be assumed to have done so without appropriate controlled trials. Overall, they consider that their results will help those who manage men with early prostate cancer in deciding on their preferred form of therapy.