Prostate cancer treatments have differential effect on quality of life, survey indicates

A quality-of-life survey of almost 3000 European men who received treatment for prostate cancer reveals that loss of sexual function is a “big” or “moderate” problem in half. The adverse impact of radiotherapy on sexual function is worse than that for radical prostatectomy, although respondents indicated that both have a severe impact.

Findings from the Europa Uomo Patient Reported Outcomes Study (EUPROMS) were reported by André Deschamps at the 2020 European Association of Urology Virtual Congress.

“The data collected and the analysis done provide patients and health care professionals a snapshot on the impact of treatments based on the experiences of fellow patients,” said Deschamps, Europa Uomo chairman, Antwerp, Belgium. “We hope that these results will be used to establish and disseminate realistic expectations on the effects of the different treatments for prostate cancer on quality of life.”

The findings indicate that patients who undergo radical prostatectomy (RP) report worse urinary incontinence than those undergoing radiation therapy, sexual function score is the lowest among men receiving radiation therapy, fatigue and insomnia scores are the worst among men undergoing radiation therapy or chemotherapy, and chemotherapy leads to the worst quality-of-life outcomes.

Because active surveillance has the least impact of any prostate cancer treatment on quality of life, “active surveillance should be promoted as the first option for treatment for those men where it can be offered safely,” said Deschamps.

EUPROMS gathered data from 2943 European men from 24 countries who were asked to complete a 20-minute online survey with the intent of examining quality of life of patients with prostate cancer. The study used validated quality-of-life questionnaires (EPIC-26, EORTC-QLQ-C30, and EQ-5D-5L) available in 19 languages. The current mean age of respondents was 70 years and their mean age at diagnosis was 64 years.

Two-thirds of the respondents received 1 treatment for prostate cancer, 22% received 2 treatments, 19% received 3, and 2% received 4 or more.

The highest symptom scores on the EORTC-QLQ-C30 scale were fatigue, with a mean score of 25 out of a possible 100 (low scores are positive), and insomnia, with a mean score of 24. Radiation therapy doubled the reported fatigue compared with RP (mean score: 22 vs 11). Chemotherapy also led to an increase in reported fatigue (mean score: 33). Insomnia appeared to be a function of progression of disease rather than the treatment received, said Deschamps, but chemotherapy did lead to an increase in reported insomnia. Active surveillance had no impact on insomnia.

Urinary incontinence and sexual function were the most prevalent symptoms on the EPIC-26, in which high scores are positive. RP had the largest reported impact on urinary incontinence, with scores ranging from 65 to 73 depending on other treatments received, compared with scores of 73 to 100 reported by patients receiving radiation therapy. The mean urinary incontinence score of patients on active surveillance was 100. Radiation therapy led to worse sexual function scores than RP. Scores ranged from 15 to 18 among those treated with radiation compared with scores of 15 to 26 among the men receiving RP. Men who received chemotherapy had the lowest sexual functioning score (mean: 12). Men on active surveillance reported a mean sexual function score of 57.

Deschamps said that the results of the survey are not comparable to results from clinical studies using the same validated questionnaires, and that further investigation into this issue is ongoing.

“Reported quality of life is best in patients where the cancer is discovered in an early, curable stage. Hence, efforts toward early detection and awareness are essential to avoid unnecessary deterioration of quality of life,” he said.

The large sample size, assessment at long-term follow-up (6 years post-diagnosis), and the use of validated questionnaires are among the strengths of EUPROMS, commented Steven Joniau, MD, PhD, consultant urologist, University Hospitals, Leuven, Belgium, who was not involved in the study. Weaknesses include its cross-sectional design, lack of a baseline assessment, and its observational nature.

Because younger and healthier patients more likely underwent surgery and older, less healthy patients likely received radiation therapy, better insight into the tumor characteristics and the age and comorbidity profiles of included patients is needed, said Joniau.

The study was sponsored by Bayer, Ipsen, and Janssen.

Reference

Deschamps A. The real effect of prostate cancer treatment: EUPROMS study first patient driven quality of life study ever. 2020 European Association of Urology Virtual Congress. July 17-26, 2020.

<<<More from the 2020 EAU Annual Congress