[Temporal changes in quality of life after prostate carcinoma]

Each year more than 60,000 German men are diagnosed with prostate cancer. The incidence nearly doubled in the last 10 years due to intensified use of PSA testing for early detection. To date, either radical prostatectomy or radiotherapy is recommended for treatment of localized prostate cancer. Both strategies have similar survival chances (83-94%), but show different side effects. In view of the good prognosis implications for health-related quality of life (QoL) may play an important role in the therapy decision-making process and should be discussed with patients.

Prostate cancer patients were asked twice about oncological health care and QoL (EORTC QLQ-C30, Version 2) as part of the OVIS study conducted in Schleswig-Holstein. The first questioning took place 16 months after the initial diagnosis and the second one at month 42. QoL was compared with German reference data. Logistic regression identified predictors for (a) low QoL at baseline (as indicated by global health status/QoL below the group median) and (b) clinically relevant detriments, defined as a difference of ≥10 points, in the chronological sequence.

Prostate cancer patients (n=1,345; median age at diagnosis 66 years) report a mean global QoL score that is higher than that of a healthy German reference sample (difference 6.3). In the temporal course, 56% of patients did not experience a clinically relevant change in QoL (<10 points difference). However, 20% reported a clinically relevant decrease and 24% a clinically relevant increase (≥ 10 points difference) regarding global health status/QoL. Higher age, lower social class, chemotherapy, undesired side effects and long-term complications as well as rehabilitative care predict low QoL at baseline, while progression of the disease and living in an urban surrounding as well as young age at diagnosis predict a decrease of QoL in the chronological sequence.

Self-reported QoL of prostate cancer patients depends on various personal and medical factors. Physicians should be aware of these factors and include them in the discussion about the appropriate therapy method with their patients. In general, therapists and family members have problems describing the QoL of their patients and relatives. Assessing the QoL and QoL-influencing factors with a short questionnaire seems to be feasible and may be helpful in the therapy decision-making process.