Long-term health-related quality of life after curative treatment for prostate cancer: a regional cross-sectional comparison of two standard treatment modalities.

Effects on long-term health-related quality of life (HRQoL) were evaluated in patients treated for localized prostate cancer by two standard modalities: radical retropubic prostatectomy (RP) and external beam radiotherapy combined with a high-dose-rate brachytherapy boost (HDRBT-EBRT). The HRQoL data were compared with age-adjusted normative data. Men diagnosed with localized prostate cancer and treated with curative intent in Gothenburg, Sweden, 1988-1997 were included. HRQoL was measured in October 2000 using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires, with a response rate of 82% (n=347). No differences in patient characteristics were found between the two treatment groups, except regarding tumor stage and PSA recurrence at the time of the questionnaires. In the RP group, 42% had T1 and 6% had T3-4 tumors; corresponding proportions in the HDRBT-EBRT group were 29% and 13% (p=0.01). PSA recurrence was detected in 44% of RP patients and 9% of HDRBT-EBRT patients. In most domains, mean HRQoL scores were high and similar to the scores for the age-adjusted normative sample. However, patients reported better role and physical function compared to the normal population. We also observed more sleeping disturbances but less pain among patients than in the normal population. The disease-specific questionnaires showed statistically significant higher levels of bowel and urinary problems in the irradiated group than in the RP group, and the absolute difference between the groups was small and had minor clinical significance. We conclude that overall the general quality of life was rated high by the patients irrespective of curative treatment modality and in agreement with age-adjusted normative data. Statistically significant differences in bowel and urinary symptoms were found between the two treatment groups in favor of the RP group, but the clinical significance was small.