Health-related quality of life after the diagnosis of locally advanced or advanced prostate cancer

Background:
Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or advanced disease. Few studies consider longer-term impact of disease progression and treatment adverse effects on health-related quality of life (QoL) of these men.

Objective:
Describe changes in health-related QoL over 5 years for men with newly diagnosed locally advanced or advanced prostate cancer.

Interventions/Methods:
Eighty-one men with locally advanced or advanced prostate cancer referred to the study by their treating urologist completed a self-administered questionnaire assessing distress, cancer-specific distress, decision regret, satisfaction with life, and global and disease-specific health-related QoL. Questionnaires were administered close to diagnosis (baseline), 2, 6, 12, 24, 36, 48, and 60 months’ follow-up.

Results:
Men were of mean age 68.3 (SD, 7.9) years and at mean of 31.9 (SD, 50.5) days postdiagnosis. The most common treatment received was androgen deprivation therapy (95.1%) or radiation therapy (79%). The proportion of men classified as distressed (Distress Thermometer) ranged from 46.3% (baseline) to 32.6% (60 months). Decrements in physical QoL were found at 2, 6, 12, 24, 36, and 48 months compared with baseline. Life satisfaction ratings were lower at 6 months compared with baseline. Sexual concerns were consistently high across the 5 years (Expanded Prostate Cancer Index Composite <30).

Conclusions:
In the context of advanced disease, results indicate that health-related QoL fluctuates from diagnosis to 5 years later. A substantial proportion remained distressed at 5-year follow-up.

Implications for Practice:
Care frameworks supporting ongoing assessment of health-related QoL concerns of men with advanced prostate cancer are needed with a particular focus on sexual adjustment.