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MP58-20 HEALTH-RELATED QUALITY OF LIFE IN MEN UNDERGOING ACTIVE SURVEILLANCE VS. RADICAL PROSTATECTOMY FOR LOW RISK PROSTATE CANCER: A PROSPECTIVE MULTI-INSTITUTIONAL STUDY
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
function compared to UC drainage. Data accrual is underway to assess trends in larger population. Source of Funding: none
MP58-19 PATIENT-REPORTED HEALTH RELATED QUALITY-OF-LIFE (HRQOL) OUTCOMES OF PATIENTS ON ACTIVE SURVEILLANCE: RESULTS OF A PROSPECTIVE, LONGITUDINAL, SINGLE-CENTER STUDY Cesar Ercole*, Tracy Krebs, Donna Prots, Ryan Berglund, Jay Ciezki, Steven Campbell, Amr Fergany, Michael Gong, Georges-Pascal Haber, Stephen Jones, Jihad Kaouk, Eric Klein, Matthew Simmons, Robert Stein, Kevin Stephans, Rahul Tendulkar, Tianming Gao, Andrew Stephenson, Cleveland, OH INTRODUCTION AND OBJECTIVES: Treatment options for clinically localized PCa may negatively impact a patient’s HRQOL to varying degree. Active surveillance (AS) offers patients the potential for preservation of HRQOL without compromising curability. However, there is a lack of prospective, patient-reported data on the HRQOL outcomes of patients managed by AS relative to radical prostatectomy (RP) and brachytherapy (BT). From a prospective, longitudinal HRQOL protocol using validated instruments for patient-reported functional outcomes, we analyzed voiding, bowel, sexual function, urinary incontinence, and physical/emotional functioning among patients managed by AS, RP, and BT at our institution. METHODS: Between 2007-2013, 591 patients PCa were enrolled in a prospective, longitudinal HRQOL protocol. HRQOL domains were assessed at various time points by a 48-item validated HRQOL instrument (Giesler et al. Qual Life Res 2000). Overall, 67 patients were managed by AS, 116 by BT, and 407 with RP (174 open and 223 robotic). A mixed effect model with random intercepts was fitted to the longitudinal data. The time was treated as categorical instead of continuous to reflect possible non-linear time trend. RESULTS: Statistically significant differences for BT compared to AS and RP were noted for voiding (irritative and obstructive symptoms) and bowel function, where patients reported worsening symptoms as soon as 6 months with partial recovery 12 months (P value < 0.001 for all). Erectile function and incontinence were most affected by RP when compared to AS and BT, with recovery also noted 12 months (P value < 0.001 for all). Each domain is illustrated in Figure 1. CONCLUSIONS: HRQOL among patients on AS is stable over 1-2 years for all domains. Urinary and bowel function for AS is significantly better than BT. Sexual function and incontinence for AS is significantly better than RP. This information is anticipated to be useful for patients and physicians when deciding upon the merits of AS over radical therapy for the treatment of localized PCa.
Source of Funding: Robert Wood Johnson Foundation
e665
MP58-20 HEALTH-RELATED QUALITY OF LIFE IN MEN UNDERGOING ACTIVE SURVEILLANCE VS. RADICAL PROSTATECTOMY FOR LOW RISK PROSTATE CANCER: A PROSPECTIVE MULTIINSTITUTIONAL STUDY Claudio Jeldres*, Khanh Pham, Richard B. Johnston, Seattle, WA; Jennifer Cullen, Rockville, MD; Katherine Odem-Davis, Erika Wolff, Katherine Levie, Seattle, WA; Lauren Hurwitz, Rockville, MD; Christopher R. Porter, Seattle, WA INTRODUCTION AND OBJECTIVES: Use of definitive therapy in patients with low risk prostate cancer (PCa) runs the risk of unnecessary loss of quality of life for those who harbour non-aggressive tumors due to side effects of surgery or radiation therapy. Conversely, active surveillance (AS) can potentially confer a transient gain of health related-quality of life (HRQoL) by delaying definitive therapy for those who will progress during expectant management. We hypothesized that both AS and radical prostatectomy (RP) will negatively affect HRQoL, but ultimately AS may exhibit better HRQoL outcomes in patients with low-risk PCa. METHODS: From January 2007 to December 2011, male patients from 8 Institutions across the US were prospectively enrolled into the Center for Prostate Disease Research national database. Baseline and follow-up HRQoL data was collected using two standardized instruments: the Medical Outcomes Study Short Form (SF)-36 and the Expanded Prostate Cancer Index Composite (EPIC) v 2002. Men included in this study had biopsy-confirmed low risk PCa, per NCCN guidelines, and selected either AS or RP. Statistics to compare score changes in EPIC and SF-36 relied on Student’s t-test. RESULTS: The study included 175 RP and 103 AS patients that had baseline, 1-year, and 2-year HRQoL data. The mean baseline EPIC standardized sexual function score (range ¼ 0-100) was 50.7 for RP patients vs. 46.8 for AS patients. At 1- and 2-year intervals, significant declines were observed for both groups, but larger declines were seen in the RP group (2-year: -25.4, 95%CI: -30.3, -20.5) vs. AS group (2-year: -7.5, 95%CI: -12.8, -2.2) [p<0.001]. Similarly, EPIC urinary function decline assessment showed worse score changes for the RP group (2-year: -14.0, 95%CI: -17.5, -10.6) vs. AS group (2-year: -4.6, 95%CI: -9.1, -0.1) [p<0.001]. No statistically significant differences were found for bowel function (EPIC), physical health (SF-36) and mental health (SF-36) between the two groups or when compared to baseline. CONCLUSIONS: At two years after diagnosis of prostate cancer, men will suffer significant loss of health-related quality of life, specifically in both sexual and urinary function. Those undergoing radical prostatectomy will have a larger loss than those on active surveillance. Neither bowel function nor mental health seems to be significantly affected by the diagnosis and management of low-risk prostate cancer. Source of Funding: none
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
function compared to UC drainage. Data accrual is underway to assess trends in larger population. Source of Funding: none
MP58-19 PATIENT-REPORTED HEALTH RELATED QUALITY-OF-LIFE (HRQOL) OUTCOMES OF PATIENTS ON ACTIVE SURVEILLANCE: RESULTS OF A PROSPECTIVE, LONGITUDINAL, SINGLE-CENTER STUDY Cesar Ercole*, Tracy Krebs, Donna Prots, Ryan Berglund, Jay Ciezki, Steven Campbell, Amr Fergany, Michael Gong, Georges-Pascal Haber, Stephen Jones, Jihad Kaouk, Eric Klein, Matthew Simmons, Robert Stein, Kevin Stephans, Rahul Tendulkar, Tianming Gao, Andrew Stephenson, Cleveland, OH INTRODUCTION AND OBJECTIVES: Treatment options for clinically localized PCa may negatively impact a patient’s HRQOL to varying degree. Active surveillance (AS) offers patients the potential for preservation of HRQOL without compromising curability. However, there is a lack of prospective, patient-reported data on the HRQOL outcomes of patients managed by AS relative to radical prostatectomy (RP) and brachytherapy (BT). From a prospective, longitudinal HRQOL protocol using validated instruments for patient-reported functional outcomes, we analyzed voiding, bowel, sexual function, urinary incontinence, and physical/emotional functioning among patients managed by AS, RP, and BT at our institution. METHODS: Between 2007-2013, 591 patients PCa were enrolled in a prospective, longitudinal HRQOL protocol. HRQOL domains were assessed at various time points by a 48-item validated HRQOL instrument (Giesler et al. Qual Life Res 2000). Overall, 67 patients were managed by AS, 116 by BT, and 407 with RP (174 open and 223 robotic). A mixed effect model with random intercepts was fitted to the longitudinal data. The time was treated as categorical instead of continuous to reflect possible non-linear time trend. RESULTS: Statistically significant differences for BT compared to AS and RP were noted for voiding (irritative and obstructive symptoms) and bowel function, where patients reported worsening symptoms as soon as 6 months with partial recovery 12 months (P value < 0.001 for all). Erectile function and incontinence were most affected by RP when compared to AS and BT, with recovery also noted 12 months (P value < 0.001 for all). Each domain is illustrated in Figure 1. CONCLUSIONS: HRQOL among patients on AS is stable over 1-2 years for all domains. Urinary and bowel function for AS is significantly better than BT. Sexual function and incontinence for AS is significantly better than RP. This information is anticipated to be useful for patients and physicians when deciding upon the merits of AS over radical therapy for the treatment of localized PCa.
Source of Funding: Robert Wood Johnson Foundation
e665
MP58-20 HEALTH-RELATED QUALITY OF LIFE IN MEN UNDERGOING ACTIVE SURVEILLANCE VS. RADICAL PROSTATECTOMY FOR LOW RISK PROSTATE CANCER: A PROSPECTIVE MULTIINSTITUTIONAL STUDY Claudio Jeldres*, Khanh Pham, Richard B. Johnston, Seattle, WA; Jennifer Cullen, Rockville, MD; Katherine Odem-Davis, Erika Wolff, Katherine Levie, Seattle, WA; Lauren Hurwitz, Rockville, MD; Christopher R. Porter, Seattle, WA INTRODUCTION AND OBJECTIVES: Use of definitive therapy in patients with low risk prostate cancer (PCa) runs the risk of unnecessary loss of quality of life for those who harbour non-aggressive tumors due to side effects of surgery or radiation therapy. Conversely, active surveillance (AS) can potentially confer a transient gain of health related-quality of life (HRQoL) by delaying definitive therapy for those who will progress during expectant management. We hypothesized that both AS and radical prostatectomy (RP) will negatively affect HRQoL, but ultimately AS may exhibit better HRQoL outcomes in patients with low-risk PCa. METHODS: From January 2007 to December 2011, male patients from 8 Institutions across the US were prospectively enrolled into the Center for Prostate Disease Research national database. Baseline and follow-up HRQoL data was collected using two standardized instruments: the Medical Outcomes Study Short Form (SF)-36 and the Expanded Prostate Cancer Index Composite (EPIC) v 2002. Men included in this study had biopsy-confirmed low risk PCa, per NCCN guidelines, and selected either AS or RP. Statistics to compare score changes in EPIC and SF-36 relied on Student’s t-test. RESULTS: The study included 175 RP and 103 AS patients that had baseline, 1-year, and 2-year HRQoL data. The mean baseline EPIC standardized sexual function score (range ¼ 0-100) was 50.7 for RP patients vs. 46.8 for AS patients. At 1- and 2-year intervals, significant declines were observed for both groups, but larger declines were seen in the RP group (2-year: -25.4, 95%CI: -30.3, -20.5) vs. AS group (2-year: -7.5, 95%CI: -12.8, -2.2) [p<0.001]. Similarly, EPIC urinary function decline assessment showed worse score changes for the RP group (2-year: -14.0, 95%CI: -17.5, -10.6) vs. AS group (2-year: -4.6, 95%CI: -9.1, -0.1) [p<0.001]. No statistically significant differences were found for bowel function (EPIC), physical health (SF-36) and mental health (SF-36) between the two groups or when compared to baseline. CONCLUSIONS: At two years after diagnosis of prostate cancer, men will suffer significant loss of health-related quality of life, specifically in both sexual and urinary function. Those undergoing radical prostatectomy will have a larger loss than those on active surveillance. Neither bowel function nor mental health seems to be significantly affected by the diagnosis and management of low-risk prostate cancer. Source of Funding: none