Quality of Life in Men Undergoing Radical Prostatectomy for Prostate Cancer

Abstract:

Prostate cancer is the most common noncutaneous cancer in men and the second-leading cause of death from cancer in men in the United States. Approximately one in six men will be diagnosed with the disease during his lifetime. When a man is diagnosed with clinically localized prostate cancer, he is immediately faced with a number of complex issues regarding the management of the disease. Options available to him include surgical management in the form of radical prostatectomy, radiotherapy including external beam radiation therapy and brachytherapy, hormone ablation, and expectant management or active surveillance (i.e., “watchful waiting”).

Radical prostatectomy remains one of the most important tools for localized disease – a “gold-standard” for definitive treatment to which novel therapies are compared (Table 167-1 ). It is estimated that in the United States that approximately 77,000 of the procedures are performed annually. To assist clinicians along these lines, several validated questionnaires have been developed and are commonly used to monitor quality of life changes in patients as they relate to treatment of localized prostate cancer. Providers who treat localized prostate cancer should be familiar with and utilize these instruments as part of their routine post-treatment evaluation of patients over time (Table 167-2 ).

Table 167-1 Key facts about radical prostatectomy

Table 167-2 Commonly-used and validated measures of QOL after radical prostatectomy

Improved understanding of the side effects of interventions and their impact of health-related quality of life (HRQOL) is an important part of understanding of the impact of the cancer as well as the modalities to treat the malignancy. To this end, HRQOL assessments have become and important area of interest with respect to radical prostatectomy. Researchers have evaluated many different aspects of this topic, including the impact of comorbidities, socioeconomic status, type of prostatectomy, as well as comparisons to other treatments for prostate cancer. However, despite the potential for side effects, overall satisfaction with the surgery remains high, and patients report little decrease in their overall quality of life. A thorough understanding of these issues is essential for clinicians who must assist their patients through complicated decision processes once they are diagnosed with localized prostate cancer.