Trends in Quality of Life Outcomes 5 Years After Prostatectomy

Abstract

Introduction Prostate cancer is the second most common cause of cancer and continues to be the second leading cause of cancer death among American men. Those diagnosed with prostate cancer can choose to undergo prostatectomy as their treatment. The success of a prostatectomy cannot only be measured by the survival duration, but must also take into consideration the quality of life the patient can expect immediately and years after the treatment is complete. With the 10 year survival rate after prostatectomy being as high as 83%, it is imperative to gain a better understanding how treatment impacts patients’ lives. Materials & Methods Patients who had prostate cancer underwent prostatectomy at the University of Vermont Medical Center. Their health-related quality of life was measured using the Expanded Prostate Cancer Index Composite (EPIC), which is a validated instrument that specifically monitors for urinary incontinence, urinary irritation/obstruction, bowel, sexual, and vitality/hormonal effects. Each category is scored out of 12 points where a higher score represent a stronger dysfunction. EPIC was given to patients to fill out during their follow-up appointments every 6 months after their surgery. All the EPIC responses for each time point was averaged and graphed to trend the response over the next 5 years after treatment. Results The number of EPIC responses recorded for each time point after prostatectomy was 0.5 years (n=224), 1 years (n=125), 1.5 years (n=98), 2 years (n=94), 2.5 years (n=53), 3 years (n=50), 3.5 years (n=44), 4 years (n=37), 4.5 years (n=22), and 5 years (n=14). Urinary incontinence responses was highest 0.5 year after prostatectomy and decreases and stabilizes by 1.5 years after prostatectomy. Urinary irritation/obstruction responses was highest 0.5 year after prostatectomy and decreases down to the lowest score at 2.5 years after prostatectomy before gradually increasing. Bowel responses was highest at 4.5 years after prostatectomy. Sexual responses was highest 0.5 year after prostatectomy and decreases and stabilizes by 2.5 years after prostatectomy. Vitality/hormonal responses did not follow a discernible pattern over the years after prostatectomy. Total responses was highest 0.5 year after prostatectomy and gradually decreased until 2.5 years after prostatectomy before slightly increasing for the remaining time. Conclusions Out of all the symptoms, prostatectomy seemed to have the biggest effect on sexual response with a score of 8.4 six months after surgery and seems to slightly improve with time and stabilize by 2.5 years, but still remains a big problem at a score of 6.2 five years after surgery. The second biggest problem prostatectomy caused is urinary incontinence, which gradually improved with about 40% reduction in symptoms by five years after surgery. Prostatectomy caused the least bowel adverse effects with the patients surveyed showing a decreasing score over the first 3 years after prostatectomy, but surprisingly increasing to an all-time high score of 1.3 at 4.5 years after prostatectomy before dropping back down at 5 years after surgery. Patients undergoing prostatectomy will most likely experience some adverse effects from their treatment that persist for more than 5 years