Objective: To analyse health-related quality of life (HRQoL) and satisfaction with care across potential curative treatments for older patients newly diagnosed with prostate cancer.
Patients and methods: In a prospective cohort study we recruited 115 older patients (> or =65 years) newly diagnosed with prostate cancer from the urology clinics of an urban academic and a Veterans' Administration (VA) hospital. Patients completed generic (Short Form-36), prostate-specific (University of California Los Angeles Prostate Cancer Index) HRQoL, and Client Satisfaction with Care (CSQ-8) surveys before treatment with either radical prostatectomy (RP) or external beam irradiation (EBRT) and at 3, 6 and 12 months afterward. Clinical and demographic data were obtained via medical chart review. A repeated-measures analysis of variance was used to examine changes in generic and prostate cancer-specific HRQoL between treatments. Log-linear regression was used to analyse the factors associated with 12-month HRQoL scores, and Kaplan-Meier survival curves were used to compare the return to baseline values for HRQoL.
Results: The RP group had significantly higher income, education and better general health than the EBRT group. Age (odds ratio 0.5, 95% confidence interval 0.32-0.82), non-VA hospital (28.8, 2-402) and prostate-specific antigen level at diagnosis (2.8, 1.05-7.5) were associated with RP. The analysis results indicated that the RP group had higher scores for generic HRQoL subscales of physical function (P = 0.019), role emotional (P = 0.037), vitality (P = 0.033) and general health (P = 0.05) than the EBRT group. A log-linear regression model for predicting the 12-month scores showed that RP was associated with higher scores for most of the generic HRQoL and bowel function (odds ratio 1.12, P = 0.03), urinary bother (1.6, P = 0.014) and bowel bother (1.5, P = 0.013). Being older was associated with a lower score on bowel function (0.98, P = 0.05) and sexual function (0.92, P = 0.05). Satisfaction with care was comparable between treatment groups at baseline and at the follow-up.
Conclusions: Older patients tolerate RP well from the HRQoL perspective and thus decisions for therapy in this age cohort should not be based primarily on age.