Low-risk prostate cancer: evaluation of quality of life after surgical treatment and during active observation

Abstract

The study objective is to improve results of treatment of patients with low-risk prostate cancer (PC).Materials and methods. In the study, comparative analysis of data from 84 patients with low-risk PC was performed: 40 patients were included in the active observation group (group 1) and 44 patients underwent radical prostatectomy (group 2). For evaluation of functional responses the following questionnaires were used: Short Form 36 Health Quality Survey (SF-36), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite (EPIC-26). For control of oncological results, tests for prostate-specific antigen, digital rectal examination, magnetic resonance imaging of the pelvic organs with intravenous contrast, and confirmation biopsy of the prostate were preformed.Results. Mean score for the SF-36 questionnaire in the group 1 (active observation) at the beginning of the study was 63.2 ± 11.5 for mental health (MH) and 57.1 ± 9.8 for physical health (PH), while in the group 2 MH score was 63.1± 6.8, PH score was 56.2 ± 8.6. However, 18 months later in the group 1 mean MH score increased to 68.2 ± 10.1, mean PH score to 62.4 ± 7.8; in the group 2 PH score increased insignificantly to 64.2 ± 7.4 and PH score decreased to 54.8 ± 5.4 (p <0.05). IIEF-5 score in the group 1 decreased from 18.8 ± 4.2 to 18.3 ± 4.0, in the group 2 from 19.1 ± 4.3 to 16.9 ± 4.8 (p <0.05). Mean IPSS score insignificantly increased in the group 1 from 9.1 ± 2.1 to 9.3 ± 2.7, while in the group 2 it decreased from 9.2 ± 2.3 to 8.4 ± 1.5 (p <0.05). For the EPIC-26 questionnaire, mean score for all criteria initially was 56.1 ± 5.1 in the group 1 and 54 ± 4.4 in the group 2 (after prostatectomy), and currently it increased to 65 ± 4.6 in the group 1 and decreased to 49 ± 5.4 in the group 2.Two (5 %) patients from the group 1 underwent surgical treatment due to PC progression. One (2.5 %) patient chose surgical treatment due to cancer-related anxiety. Biochemical recurrence with an increase in prostate-specific antigen of 0.29 ± 0.09 ng/ml was observed in 3 (6,8 %) patients in the group 2.Conclusion. Strategy of active observation is the preferred method of care for patients with low-risk PC allowing to preserve high quality of life while surgical treatment should be performed only if necessary.

Keywords

• active observation
• quality of life
• prostate cancer
• low oncological risk
• prostatectomy