Comparison of health-related quality of life and prostate-associated symptoms after primary and salvage cryotherapy for prostate cancer

Abstract

Purpose

Recent advances in cryosurgery of the prostate have led to the ability to treat tumors successfully with decreased morbidity. The patients’ perspectives of this relatively new technique, however, have not yet been addressed. The purpose of this study was to compare health related quality of life (QoL) as well as prostate-associated symptoms in patients after primary and salvage cryoablation for clinically localized prostate cancer using a self-administered questionnaire.

Methods

A total of 131 consecutive patients who underwent cryoablation of the prostate between 1997 and 2001 were included in this confidential mailing study. The patients were either (a) patients with localized prostate cancer with contraindications for radical surgery, including patients refusing other forms of therapy, or (b) had locally recurrent prostate cancer after failure of radiation therapy. All patients received 3 months of neoadjuvant androgen deprivation therapy prior to cryosurgery and were surgically treated by the same surgeon using an argon-based system. We used the EORTC QLQ-C30, a commonly used, multidimensional instrument together with a supplementing, prostate-cancer-specific module.

Results

Eighty-one of the 131 patients (response rate 62%) returned the questionnaires. The two groups were comparable regarding age (mean age 72.8 vs 70.1 for the primary and the salvage group, respectively; p=0.22). The overall QoL scores were high in both groups. Primary cryotherapy patients fared significantly better regarding physical (p=0.005) and social (p=0.024) functioning compared with salvage cryotherapy patients. The most prominent prostate-related symptom in both patient groups was sexual dysfunction, followed by urinary symptoms, which were significantly more severe in the salvage group (p=0.001). Incontinence rates were 5.9 and 10% in the primary and the salvage group, respectively. Severe erectile dysfunction was reported in 86 and 90% of the primary and the salvage group, respectively.

Conclusions

The present study demonstrates that, in selected patients, cryotherapy is a treatment option which has a functional outcome comparable to traditionally used prostate cancer treatments. More information regarding QoL is necessary for appropriate patient counseling and individual decision-making in the presence of various treatment alternatives.

Appendix: Prostate-cancer-specific module supplementing the QLQ-C30 (Borghede and Sullivan 1996):

	Not at all	A little	Quite a bit	Very much
1. Are you satisfied with your bowel function?	1	2	3	4
2. Do you have bowel or intestinal bleeding?	1	2	3	4
3. Do you need to empty your bowels more than once a day?	1	2	3	4
4. Do you have involuntary leakage of feces when urinating?	1	2	3	4
5. Are you troubled with flatulence?	1	2	3	4
6. Do you have involuntary leakage of feces?	1	2	3	4
7. Are you troubled by swelling in your legs or penis?	1	2	3	4
8. Do you have pain in or around your anus?	1	2	3	4
9. Have you had any other anal symptoms, e.g., itching, fragile skin, hemorrhoids?	1	2	3	4
10. Have you had difficulty emptying your bladder?	1	2	3	4
11. Do you have to urinate frequently?	1	2	3	4
12. Are you troubled by leakage of urine?	1	2	3	4
13. Have you had symptoms (smarting, pins and needles, pain) from your urethra?	1	2	3	4
14. Has your urine stream deteriorated?	1	2	3	4
15. Do you suffer from hot flushes?	1	2	3	4
16. Does your condition limit your interest in sex?	1	2	3	4
17. Are you limited in your ability to have or maintain an erection?	1	2	3	4
18. Does your condition prevent you from ejaculation?	1	2	3	4
19. Does your condition interfere with your enjoyment of sex?	1	2	3	4