LOS ANGELES--A survey of men with and without prostate cancer
used four different instruments (see below) to get a clear picture
of how treatment decisions affect quality of life, and found some
surprising results, Mark S. Litwin, MD, MPH, told Oncology News
Quality of life should be considered an important medical outcome,
on a par with quantity of life, when making treatment decisions
in prostate cancer, said Dr. Litwin, of the UCLA School of Medicine.
Yet in most studies, outcome measures of various treatments are
no more sensitive than "alive versus dead."
Researchers from UCLA and the RAND Corporation measured quality
of life in 214 men treated for clinically localized prostate cancer
and 273 age-matched controls who had never had prostate cancer
diagnosed. The patients were treated with either radical prosta-tectomy
(98 patients), external-beam irradiation (56), or observation
alone (60). Patients completed a questionnaire at home, without
Surprisingly, responses to the parts of the survey reflecting
general health and well-being showed no differences between patients
and controls, Dr. Litwin said (JAMA 273:129-135, 1995). One exception
was that observation patients reported greater role limitations
due to emotional problems, which may be caused by anxiety and
uncertainty concerning the future course of their prostate cancer.
Day-to-Day Life Not Compromised
A cancer-specific questionnaire also showed no differences in
general health (excluding sexual function), "implying that
the major activities in patients' day-to-day lives are not compromised
after prostate cancer therapy, regardless of which treatment is
chosen," he said.
However, a prostate-specific instrument revealed significant differences
between patients and controls in bowel symptoms, urinary incontinence,
and sexual dysfunction. Surgery and radiation patients were worse
off functionally than observation or comparison patients. The
surprising finding was that many were not very bothered by their