Quality of Life After Open or Robotic Prostatectomy, Cryoablation or Brachytherapy for Localized Prostate Cancer

Abbreviations and Acronyms BT = brachytherapy EBRT = external beam radiation therapy HRQOL = health related quality of life ORP = open radical prostatectomy PBS = percent of baseline score QOL = quality of life RAP = robotic assisted laparoscopic radical prostatectomy RP = radical prostatectomy

Submitted for publication May 6, 2009.

Study received institutional review board approval.

* Financial interest and/or other relationship with InTouch Health Inc and Endocare Inc.

† Financial interest and/or other relationship with Endocare and Intuitive Surgical.

‡ Correspondence: Virginia Prostate Center, Eastern Virginia Medical School, 6333 Center Drive Bldg 16, Norfolk, Virginia 23502 (telephone: 757-457- 5100; FAX: 757-962-8020; e-mail: PSchellham@ aol.com).

§ Financial interest and/or other relationship with Dendreon Corp, Southwest Oncology Group, ContraVac and Theralogix.

Materials and Methods: Beginning in February 2000 all patients treated with open radical prostatectomy, robot assisted laparoscopic prostatectomy, brachytherapy or cryotherapy were asked to complete the UCLA-PCI questionnaire before treatment, and at 3, 6, 12, 18, 24, 30 and 36 months after treatment. Outcomes were compared across treatment types with statistical analysis using univariate and multivariate models.

Results: A total of 785 patients treated between February 2000 and December 2008 were included in the analysis with a mean followup of 24 months. All health related quality of life domains were adversely affected by all treatments and recovery profiles varied significantly by treatment type. Overall urinary function and bother outcomes scored significantly higher after brachytherapy and cryotherapy compared to open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. Brachytherapy and cryotherapy had a 3-fold higher rate of return to baseline urinary function compared to open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. Sexual function and bother scores were highest after brachytherapy, with a 5-fold higher rate of return to baseline function compared to cryotherapy, open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. All 4 treatments were associated with relatively transient and less pronounced impact on bowel function and bother.

Conclusions: In a study of sequential health related quality of life assessments brachytherapy and cryotherapy were associated with higher urinary function and bother scores compared to open radical prostatectomy and da Vinci® prostatectomy. Brachytherapy was associated with higher sexual function and bother scores compared to open radical prostatectomy, robotic assisted laparoscopic radical prostatectomy and cryotherapy.