Sanda MG et al. (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358: 1250–1261

Little is known about health-related quality of life (HRQOL) in prostate-cancer survivors after contemporary first-line treatments. Accordingly, Sanda and colleagues identified the factors that influenced post-treatment HRQOL in prostate-cancer survivors, and determined their effects on patients' and their partners' satisfaction with treatment outcomes.

This multicenter study included 1,201 men (median age 63 years, 9% black) who elected to undergo radical prostatectomy, brachy-therapy, or external-beam radiotherapy as initial treatment for stage T1–T2 prostate cancer. Responses to the 'Expanded Prostate Cancer Index Composite' and 'Service Satisfaction Scale for Cancer Care' questionnaires were collected before treatment, and 2, 6, and 24 months after treatment started. At the same time points, 625 partners responded to similar questionnaires.

Changes in HRQOL strongly influenced satisfaction with outcome for both patients and their partners. Treatment-related decreases in patients' HRQOL, particularly those associated with sexual and urinary symptoms, distressed their partners and influenced partners' satisfaction with treatment outcomes. Black patients were less satisfied than white patients with their outcomes, although reasons remained obscure.

Nerve-sparing surgery mitigated the adverse effects of prostatectomy on HRQOL. Even short-duration adjuvant androgen deprivation therapy (ADT) exacerbated the adverse effects of radiotherapy or brachytherapy on HRQOL, however, and particularly impaired sexual functioning and vitality. These detriments persisted long after ADT ceased. Sanda and colleagues caution that physicians' enthusiasm for adjuvant ADT should be tempered for men with low to intermediate-risk prostate cancer, in whom it might not improve survival.