Age-specific health-related quality of life in disease-free long-term prostate cancer survivors versus male population controls—results from a population-based study



Prostate cancer (PC) and its treatment may affect PC survivors differently with respect to age. However, little is known regarding age-specific health-related quality of life (HRQoL) in PC survivors 5 years or even ≥ 10 years post-diagnosis.


The sample included 1975 disease-free PC survivors (5–16 years post-diagnosis) and 661 cancer-free population controls, recruited from two German population-based studies (CAESAR+, LinDe). HRQoL in both populations was assessed using the EORTC QLQ-C30 questionnaire. Additionally, PC survivors completed the PC-specific EORTC QLQ-PR25 questionnaire. Differences in HRQoL between survivors and controls, as well as differences according to age and time since diagnosis were analyzed with multiple regression after adjustment for age, education, stage, and time since diagnosis, where appropriate.


In general, PC survivors reported HRQoL and symptom-burden levels comparable to the general population, except for significantly poorer social functioning and higher burden for diarrhea and constipation. In age-specific analyses, PC survivors up to 69 years indicated poorer global health and social functioning than population controls. Stratification by time since diagnosis revealed little difference between the subgroups. On PC-specific symptoms, burden was highest for urinary bother and symptoms, and lowest for bowel symptoms. Younger age was associated with less urinary symptoms but higher urinary bother.


Long-term disease-free PC survivors reported overall good HRQoL, but experienced persistent specific detriments. Our data suggest that these detriments do not improve substantially with increasing time since diagnosis. Targeted interventions are recommended to prevent PC-related and treatment-related symptoms becoming chronic and to enhance social functioning.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    The Union for International Cancer Control’s. The Global Cancer Observatory - GLOBOCAN 2018 [Internet]. 2019 [cited 2019 Mar 18]. Available from:

  2. 2.

    National Coalition of Cancer Survivorship. The NCCS Definition of a “Cancer Survivor” [Internet]. [cited 2015 Jun 25]. Available from:

  3. 3.

    Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH (2011) Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev. 20(10):1996–2005

    Article  Google Scholar 

  4. 4.

    Robert Koch Institut. Zentrum für Krebsregisterdaten [Internet]. 2017 [cited 2018 Aug 29]. Available from:

  5. 5.

    National Cancer Institute. Cancer trends progress report [Internet]. 2018 [cited 2018 Aug 29]. Available from:

  6. 6.

    Jang JW, Drumm MR, Efstathiou JA, Paly JJ, Niemierko A, Ancukiewicz M, Talcott JA, Clark JA, Zietman AL (2017) Long-term quality of life after definitive treatment for prostate cancer: patient-reported outcomes in the second posttreatment decade. Cancer Med. 6(7):1827–1836

    CAS  Article  Google Scholar 

  7. 7.

    Adam S, Feller A, Rohrmann S, Arndt V (2018) Health-related quality of life among long-term (≥5 years) prostate cancer survivors by primary intervention: a systematic review. Health Qual Life Outcomes. 16(1):1–14

    Article  Google Scholar 

  8. 8.

    Adam S, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R et al (2019) Health-related quality of life in long-term survivors with localised prostate cancer by therapy—results from a population-based study. Eur J Cancer Care (Engl). 28(5):e13076.

  9. 9.

    Namiki S, Kaiho Y, Mitsuzuka K, Saito H, Yamada S, Nakagawa H et al (2014) Long-term quality of life after radical prostatectomy: 8-year longitudinal study in Japan. Int J Urol Off J Japanese Urol Assoc. 21(12):1220–1226

    Google Scholar 

  10. 10.

    Kerleau C, Guizard AV, Daubisse-Marliac L, Heutte N, Mercier M, Grosclaude P, Joly F, French Network of Cancer Registries (FRANCIM) (2016) Long-term quality of life among localised prostate cancer survivors: QALIPRO population-based study. Eur J Cancer. 63:143–153

    Article  Google Scholar 

  11. 11.

    van Stam MA, van der Poel HG, Bosch JLHR, Tillier CN, Horenblas S, Mols F et al (2017) Prevalence and correlates of mental health problems in prostate cancer survivors: a case-control study comparing survivors with general population peers. Urol Oncol Semin Orig Investig. 35(8):531.e1–531.e7

    Article  Google Scholar 

  12. 12.

    Fransson P (2008) Patient-reported lower urinary tract symptoms, urinary incontinence, and quality of life after external beam radiotherapy for localized prostate cancer—15 years’ follow-up. A comparison with age-matched controls. Acta Oncol (Madr) 47(5):852–861

    Article  Google Scholar 

  13. 13.

    Johnstone PAS, Gray C, Powell CR (2000) Quality of life in T1-3N0 prostate cancer patients treated with radiation therapy with minimum 10-year follow-up. Int J Radiat Oncol Biol Phys. 46(4):833–838

    CAS  Article  Google Scholar 

  14. 14.

    Thong MSY, Mols F, Kil PJM, Korfage IJ, Van De Poll-Franse LV (2010) Prostate cancer survivors who would be eligible for active surveillance but were either treated with radiotherapy or managed expectantly: comparisons on long-term quality of life and symptom burden. BJU Int. 105(5):652–658

    Article  Google Scholar 

  15. 15.

    Clause-Verdreau AC, Audureau É, Leplège A, Coste J (2019) Contrasted trends in health-related quality of life across gender, age categories and work status in France, 1995-2016: repeated population-based cross-sectional surveys using the SF-36. J Epidemiol Community Health. 73(1):65–72

    Article  Google Scholar 

  16. 16.

    Kurian CJ, Leader AE, Thong MSY, Keith SW, Zeigler-johnson CM (2018) Examining relationships between age at diagnosis and health-related quality of life outcomes in prostate cancer survivors. BMC Public Health. 18(1060):1–9

    Google Scholar 

  17. 17.

    Pinkawa M, Fischedick K, Gagel B, Piroth MD, Asadpour B, Klotz J et al (2009) Impact of age and comorbidities on health-related quality of life for patients with prostate cancer: evaluation before a curative treatment. BMC Cancer. 9:1–10

    Article  Google Scholar 

  18. 18.

    Hampson LA, Cowan JE, Zhao S, Carroll PR, Cooperberg MR (2015) Impact of age on quality-of-life outcomes after treatment for localized prostate cancer. Eur Urol. 68(3):480–486

    Article  Google Scholar 

  19. 19.

    Mols F, Van De Poll-Franse LV, Vingerhoets AJJM, Hendrikx A, Aaronson NK, Houterman S et al (2006) Long-term quality of life among Dutch prostate cancer survivors: results of a population-based study. Cancer. 107(9):2186–2196

    Article  Google Scholar 

  20. 20.

    Arndt V, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B et al (2017) Quality of life in long-term and very long-term cancer survivors versus population controls in Germany. Acta Oncol (Madr). 56(2):190–197

    Article  Google Scholar 

  21. 21.

    Doege D, Thong MSY, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B et al (2019) Health-related quality of life in long-term disease-free breast cancer survivors versus female population controls in Germany. Breast Cancer Res Treat. 175(2):499–510

    Article  Google Scholar 

  22. 22.

    Thong MSY, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B et al (2019) Age-specific health-related quality of life in long-term and very long-term colorectal cancer survivors versus population controls—a population-based study. Acta Oncol (Madr). 58(5):801–10

  23. 23.

    Koch-Gallenkamp L. Referenzdaten zur Lebensqualität in Deutschland für Studien mit Krebspatienten [Internet]. 2014. [cited 2018 Jun 5]. Available from:

  24. 24.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 85(5):365–376

    CAS  Article  Google Scholar 

  25. 25.

    van Andel G, Bottomley A, Fosså SD, Efficace F, Coens C, Guerif S et al (2008) An international field study of the EORTC QLQ-PR25: a questionnaire for assessing the health-related quality of life of patients with prostate cancer. Eur J Cancer. 44(16):2418–2424

    Article  Google Scholar 

  26. 26.

    Fayers P, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. Brussels Eur Organ Res Treat Cancer, Brussels, p 3

    Google Scholar 

  27. 27.

    Cocks K, King MT, Velikova G, de Castro G, Martyn St-James M, Fayers PM et al (2012) Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Eur J Cancer. 48(11):1713–1721

    CAS  Article  Google Scholar 

  28. 28.

    Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 16(1):139–144

    CAS  Article  Google Scholar 

  29. 29.

    Shin DW, Park HS, Lee SH, Jeon SH, Cho S, Kang SH et al (2018) Health-related quality of life, perceived social support, and depression in disease-free survivors who underwent curative surgery only for prostate, kidney and bladder cancer: comparison among survivors and with the general. Cancer Res Treat

  30. 30.

    Bestmann B, Loetters C, Diemer T, Weidner W, Küchler T, Rohde V (2007) Prostate-specific symptoms of prostate cancer in a German general population. Prostate Cancer Prostatic Dis. 10(1):52–59

    CAS  Article  Google Scholar 

  31. 31.

    Johansson E, Steineck G, Holmberg L, Johansson JE, Nyberg T, Ruutu M et al (2011) Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol 12:891–899

    Article  Google Scholar 

  32. 32.

    Roth AJ, Weinberger MI, Nelson CJ (2009) Prostate Cancer: Quality of life, psychosocial implications and treatment choices. Futur Oncol. 4(4):561–568

    Article  Google Scholar 

  33. 33.

    De Vibe M, Bjørndal A, Hammerstrøm KT, Kowalski K, Tipton E (2017) Mindfulness based stress reduction (MBSR) for improving health, quality of life, and social functioning in adults. Campbell Syst Rev. 11(3)

  34. 34.

    Rothenberg BML, Meropol NJ, Poplin EA, Van Cutsem E, Wadler S (2001) Mortality associated with irinotecan plus bolus fluorouracil/leucovorin: summary findings of an independent panel. Cancer. 19(18):3801–3807

    CAS  Google Scholar 

  35. 35.

    Dorey G (2007) A clinical overview of the treatment of post-prostatectomy incontinence. Br J Nurs. 16(19):1194–1199

    Article  Google Scholar 

  36. 36.

    Sprangers MA, Schwartz CE (1999) Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 48(11):1507–1515

    CAS  Article  Google Scholar 

  37. 37.

    Visser Mechteld R, Oort Frans J, van Lanschot Jan B, Van der Velden Jacobus, Kloek Jaap J, Gouma Dirk J, Schwartz Carolyn E, Sprangers MAG (2013) The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: an empirical investigation of the Sprangersand Schwartz model. Psychooncology. 22(3):515–22

  38. 38.

    Walker R, Szanton SL, Wenzel J (2015) Working toward normalcy post-treatment: a qualitative study of older adult breast and prostate cancer survivors. Oncol Nurs Forum. 42(6):E358–E367

    Article  Google Scholar 

Download references


We thank all cancer survivors and doctors, who participated in the research.


The work of Salome Adam was supported by a fellowship grant of the Béatrice Ederer-Weber Stiftung. The CAESAR+ study was supported by a grant from the German Cancer Aid [No. 108262]. The LinDe study was supported by a grant from the German Cancer Aid [No. 110231]. The funding sources were neither involved in the collection, interpretation, and analysis of the data, nor in the decision for the writing and submission of this report for publication.

Author information



Corresponding author

Correspondence to Volker Arndt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest. Authors declare that they have full control over all primary data and that the journal may review their data if required.

Ethical consent

Ethical approvals for both studies were obtained from the internal review board (ethics committee) of the medical faculty of the University of Heidelberg and by all review boards accountable for the participating cancer registries. Written informed consent was obtained from all participants. All procedures involving human participants were in accordance with the Helsinki Declaration of 1975, as revised in 1983.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(DOCX 137 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Adam, S., Doege, D., Koch-Gallenkamp, L. et al. Age-specific health-related quality of life in disease-free long-term prostate cancer survivors versus male population controls—results from a population-based study. Support Care Cancer 28, 2875–2885 (2020).

Download citation


  • Prostate cancer
  • Health-related quality of life
  • Long-term survivor
  • Population-based