Improving decisions for men with prostate cancer: translational outcomes research

We established a method to present a health related quality of life instrument in a format more readily interpretable by men with prostate cancer.

Men with clinically localized prostate adenocarcinoma treated with radical prostatectomy (220), external beam radiotherapy (56) or interstitial seed brachytherapy (60) were prospectively recruited into the study. We assessed health related quality of life outcomes prospectively at baseline and 24 months after treatment using validated instruments. We defined good, intermediate and poor function for sexual, urinary and bowel domains, including good-the best response for all items in that scale, poor-the worst response for any item and intermediate-all others. We then compared bother scores in men at each symptom level.

Men with good baseline urinary and bowel function had almost no related bother (mean +/- SD UCLA-PCI 98 +/- 9 and 99 +/- 8, respectively). Those with poor function had significant distress (mean UCLA-PCI 60 +/- 30 and 64 +/- 34) and those with intermediate function had moderate distress (mean UCLA-PCI 84 +/- 20 and 83 +/- 24, respectively). Effect size was clinically and statistically significant across groups for urinary and bowel function. Men with poor baseline sexual function had much more distress than those with intermediate function (mean UCLA-PCI 44 +/- 37 vs 71 +/- 26).

To enhance the clinical relevance of outcome analysis we grouped men by baseline function to help discern their likely levels of bother and function after treatment.