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.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The Union for International Cancer Control’s. The Global Cancer Observatory - GLOBOCAN 2018 [Internet]. UICC.org. 2019 [cited 2019 Mar 18]. Available from: https://www.uicc.org/new-global-cancer-data-globocan-2018
National Coalition of Cancer Survivorship. The NCCS Definition of a “Cancer Survivor” [Internet]. [cited 2015 Jun 25]. Available from: http://www.canceradvocacy.org/news/defining-cancer-survivorship/
Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH (2011) Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev. 20(10):1996–2005
Robert Koch Institut. Zentrum für Krebsregisterdaten [Internet]. 2017 [cited 2018 Aug 29]. Available from: https://www.krebsdaten.de/Krebs/DE/Home/homepage_node.html
National Cancer Institute. Cancer trends progress report [Internet]. 2018 [cited 2018 Aug 29]. Available from: https://progressreport.cancer.gov/after/survival#field_most_recent_estimates
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
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
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. https://doi.org/10.1111/ecc.13076
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Koch-Gallenkamp L. Referenzdaten zur Lebensqualität in Deutschland für Studien mit Krebspatienten [Internet]. 2014. [cited 2018 Jun 5]. Available from: https://www.dkfz.de/de/klinepi/Projekte/linde-Studie.html
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
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
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
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
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
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
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
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
Roth AJ, Weinberger MI, Nelson CJ (2009) Prostate Cancer: Quality of life, psychosocial implications and treatment choices. Futur Oncol. 4(4):561–568
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)
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
Dorey G (2007) A clinical overview of the treatment of post-prostatectomy incontinence. Br J Nurs. 16(19):1194–1199
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
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
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
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.
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 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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
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). https://doi.org/10.1007/s00520-019-05120-5
- Prostate cancer
- Health-related quality of life
- Long-term survivor