Quality of life for men receiving a second treatment for prostate cancer

We assessed the impact of second treatment on health related quality of life for men with prostate cancer. This issue is important because second treatment resulting from prostate specific antigen recurrence has the potential to further negatively impact health related quality of life and affect the overall value of treatment. We compared differences in health related quality of life before and after second treatment for men who had asymptomatic prostate specific antigen recurrence with those who did not have biochemical failure.

Men in this analysis (897) had localized disease, initially underwent radical prostatectomy monotherapy, and completed at least 1 health related quality of life questionnaire before and after radical prostatectomy. In this cohort 175 men underwent second treatment (nonadjuvant). The Medical Outcomes Survey Short Form-36 and UCLA Prostate Cancer Index were used to measure health related quality of life. Associations between patient groups and time on health related quality of life were analyzed using repeated measures.

Men who received a second treatment presented with more severe disease before radical prostatectomy and had worse general health related quality of life. Although health related quality of life differed significantly with time for the 2 groups, most domains for the second treatment group improved or remained stable until 15 months before second treatment, at which point they declined. Scores in the sexual functioning and role-physical domains showed clinically and statistically significant patterns of decreasing with time.

Health related quality of life is affected following second treatment but starts to decline approximately 1 year before second treatment. Not all aspects of health related quality of life decreased at the same rate, so patients should be counseled that certain domains may be affected more by additional treatment.