Professional Abstract
Objective
To compare the effects of prostate cancer treatments on quality of life, anxiety related to prostate cancer, decisional regret, prostate cancer recurrence, and healthcare utilization
Study Design
| Design Element |
Description |
| Design |
Observational: cohort study |
| Population |
1,413 patients with newly diagnosed prostate cancer in North Carolina from 2011–2013 |
Interventions/
Comparators |
- Active surveillance
- Radical prostatectomy
- EBRT
- SBRT
- Brachytherapy
|
| Outcomes |
Patient-reported quality of life (including sexual, urinary, and bowel function), anxiety related to prostate cancer, and decisional regret; prostate cancer recurrence; healthcare utilization
|
| Timeframe |
5-year follow-up for study outcomes |
This prospective observational cohort study compared the effects of five treatments for prostate cancer on patient-reported outcomes, prostate cancer recurrence, and healthcare utilization. The treatments were active surveillance, radical prostatectomy, external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT), and brachytherapy.
The research team used the North Carolina Central Cancer Registry to recruit patients. To identify patients’ treatments, the team reviewed medical records and cancer registry data. Patients completed phone surveys about quality of life, anxiety related to prostate cancer, and decisional regret before treatment initiation and 3, 12, 24, 36, and 48 months later. The team described clinically meaningful differences between treatments specific to each patient-reported outcome. Five years after treatment, the team reviewed medical records and claims data to determine prostate cancer recurrence and healthcare utilization.
The study included 1,413 patients with newly diagnosed prostate cancer in North Carolina between 2011 and 2013. Of these, 71% were white, 25% were black, and 3% were another race. The average age was 64. More than 95% of patients had stage I or II prostate cancer.
Staff from patient advocacy and clinician professional organizations helped design the study and create study materials.
Results
Compared with patients who chose active surveillance,
- Patients who chose radical prostatectomy had greater increases in sexual dysfunction and urinary incontinence at 3, 12, 24, 36, and 48 months.
- Patients who chose EBRT or brachytherapy had greater increases in sexual dysfunction, urinary obstruction, and bowel problems at three months but not at other times.
- Patients who chose SBRT had lower anxiety about prostate cancer at 24 months but not at other times.
Patients did not differ in decisional regret across treatment groups.
Patients who chose SBRT or EBRT had a 51% decreased risk of prostate cancer recurrence within five years (hazard ratio=0.49) relative to patients who had radical prostatectomy.
Compared with patients who chose other treatments, patients who chose active surveillance had, on average per year, more physician visits related to prostate cancer (6.1 versus 4.6), total physician visits (7.6 versus 6.1), and urology or oncology specialist visits (5.1 versus 4.1).
Limitations
Patients chose their treatment, which may have influenced how they answered surveys. Most patients who chose active surveillance went on to choose another treatment later, which limited data available for patients who used active surveillance for five years.
Conclusions and Relevance
In this study, different treatment strategies were associated with distinct effects on patient quality of life, healthcare utilization, and prostate cancer recurrence. Patients and physicians can use these findings in combination with patients’ expressed preferences to choose a prostate cancer treatment that works best for them.
Future Research Needs
Future research can examine outcomes for patients who continue with active surveillance long term.
