Maintaining quality of life after prostate cancer diagnosis

Knowledge of real-life factors that are associated with men’s self-assessed quality of life after prostate-cancer diagnosis could improve the support from health-care professionals in maintaining the men’s quality of life. Sudden, unwelcome and repetitive thoughts about a traumatic event – intrusive thoughts – constitute one factor of post-traumatic stress disorder. Recurrent thoughts of death, not just fear of dying, are one indicator for depressive disorder. Prior research suggests that psychological interventions targeting intrusive thoughts could facilitate coping with a traumatic event such as the diagnosis of prostate cancer. In this thesis the focus was on exploring and describing men’s thoughts after prostate cancer diagnosis. The aim was to find suitable targets for interventions that can help men in maintaining their quality of life after radical prostatectomy as well as to identify those individuals who might need them most. Methods Following a one-year preparatory-phase including in-depth interviews, observations, questionnaire development, face-to-face validation and a pilot-study, the LAPPRO trial started inclusion on September 1 2008. Men planned for open or robot-assisted laparoscopic radical prostatectomy at 13 urological centers in Sweden were prospectively registered. During the first inclusion year, 971 men were enrolled, of which 833 (86%) answered two questionnaires, before and three months after surgery. These included questions on quality of life, intrusive thoughts, thoughts about death and care-related factors, among others. Results Before surgery, 603 men (73%) reported having negative intrusive thoughts about their prostate cancer at some time, as did 493 (59%) three months after surgery. Comparing those reporting negative intrusive thoughts at least weekly before surgery with those not reporting this, the prevalence ratio (PR) for waking up with anxiety after surgery was 3.9, for depressed mood 1.8 and for impaired self-assessed quality of life 1.3. Men uncertain of cure by the planned surgery (PR 1.9), not prepared for urinary (PR 1.3) or sexual bother (PR 1.3) had more occurrence of negative intrusive thoughts before surgery. Reporting negative intrusive thoughts before surgery predicted reporting such thoughts three months after surgery (Adjusted Odds Ratio (OR) 3.6). Multivariate analysis revealed that younger age (OR 1.8), living alone (OR 1.7), and non-active health-care seeking (OR 0.5) predicted the occurrence of negative intrusive thoughts three months after surgery. Twenty-five percent of the participants reported thoughts about their own death at least once a week during the previous month, before surgery and 18 percent three months after surgery. Men living in urban environment (OR 2.3) and those reporting having low control in their lives (OR 2.2), being uncertain of the future (OR 3.3) or crying (OR 2.0) before surgery, more often had thoughts about their own death three months after surgery. Findings A number of men diagnosed with clinically localized prostate cancer planned for surgery experienced intrusive thoughts with negative content as well as thoughts about their own death both before and three months after surgery. These thoughts were associated with various symptoms of psychological distress such as crying, feeling lack of control, uncertainty and not being prepared. Certain individuals seemed to be more vulnerable than others. Conclusion Despite the availability of treatments that can cure, the diagnosis of cancer is still frightening. The upcoming surgery for prostate cancer seems to lead to the accumulation of psychological reactions among men. Screening for and recognizing distressing thoughts could be valuable in supporting men shortly after prostate cancer diagnosis to maintain their quality of life. Intervention studies aiming at neutralizing negative intrusive thoughts, such as by expressive writing, could be designed based on our findings

Patient and tumour-related factors for prediction of urinary incontinence after radical prostatectomy.

Abstract Objective. The aim of this study was to identify preoperative patient and tumour-related factors associated with 12 months postoperative urinary incontinence. Material and methods. In total, 1529 men who had undergone radical prostatectomy for clinically localized prostate cancer between September 2008 and February 2010 at 15 Swedish hospitals completed a questionnaire before, 3 and 12 months after surgery. Urinary leakage, comorbidity and possible confounders were measured by self-administered validated questionnaires. Clinical data were collected preoperatively and postoperatively. The primary outcome, incontinence, was defined as the change of one pad or more per day. The ratio of proportions, estimated according to the log-binomial regression model, was analysed for 38 different factors and is presented as relative risks with 95% confidence intervals. Age-adjusted relative risk was calculated in the corresponding bivariate regression model. Results. Prospective data were available from 1360 men (response rate 89%). Results showed that age at surgery predicts long-term urinary incontinence exponentially. Patients reporting urinary leakage before prostate cancer diagnosis had an age-adjusted relative risk of 1.8 (95% confidence interval 1.3-2.4) for incontinence 12 months postoperatively. No statistically significant correlation was found between previous transurethral resection of the prostate, high body mass index or the other 34 evaluated factors and postoperative incontinence. Conclusions. Of 38 possible risk factors only age at surgery and preoperative urinary leakage were associated with 12 months postoperative incontinence in this study comprising 1360 men operated with radical prostatectomy. These findings may help the surgeon to have a targeted risk conversation with the patient before the treatment decision is made

Pain and Mean Absorbed Dose to the Pubic Bone After Radiotherapy Among Gynecological Cancer Survivors.

PURPOSE: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. METHODS AND MATERIALS: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. RESULTS: We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses /=52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. CONCLUSIONS: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer

Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors

Background: During radiotherapy unwanted radiation to normal tissue surrounding the tumor triggers survivorship diseases; we lack a nosology for radiation-induced survivorship diseases that decrease bowel health and we do not know which symptoms are related to which diseases. Methods: Gynecological-cancer survivors were followed-up two to 15 years after having undergone radiotherapy; they reported in a postal questionnaire the frequency of 28 different symptoms related to bowel health. Population-based controls gave the same information. With a modified factor analysis, we determined the optimal number of factors, factor loadings for each symptom, factor-specific factor-loading cutoffs and factor scores. Results: Altogether data from 623 survivors and 344 population-based controls were analyzed. Six factors best explain the correlation structure of the symptoms; for five of these a statistically significant difference (

Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial.

Robot-assisted laparoscopic radical prostatectomy (RALP) has become widely used without high-grade evidence of superiority regarding long-term clinical outcomes compared with open retropubic radical prostatectomy (RRP), the gold standard

Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery.

Many elderly or impotent men with prostate cancer may not receive a bundle-preserving radical prostatectomy as a result of uncertainty regarding the effect on urinary incontinence

Short-term Results after Robot-assisted Laparoscopic Radical Prostatectomy Compared to Open Radical Prostatectomy.

Robot-assisted laparoscopic radical prostatectomy has become a widespread technique despite a lack of randomised trials showing its superiority over open radical prostatectomy