Most men diagnosed with low risk prostate cancer (PCa) undergo definitive therapy when active surveillance (AS) is a viable option. Now a new study published in The Journal of Urology finds that patients who choose AS experience a health-related quality of life (HRQoL) over the short term similar to that of men with a negative prostate biopsy who ostensibly had the same stresses from testing.

“Our results suggest that for at least 3 years men selecting AS do not experience a substantial psychological burden or clinically significant problems due to untreated disease,” according to lead investigator Christopher R. Porter, MD, FACS, of Virginia Mason Medical Center in Seattle and colleagues. “This study provides important data that can be used to inform comparable patients when considering management options for low risk prostate cancer.”

In a novel, prospective, multi-center study, Dr Porter and his team compared 89 racially-diverse men with low-risk PCa on AS (mean age 64 years, at baseline) with 420 clinically and psychologically similar men (mean age 61 years) without cancer who also underwent transrectal ultrasound-guided (TRUS) biopsy from 2007 to 2014. All were military health beneficiaries enrolled in the Center for Prostate Research Multicenter National Database. Low-risk PCa was defined as clinical stage T1 to T2a, biopsy Gleason score 6 or less, and PSA less than 10 ng/mL, in accordance with National Comprehensive Cancer Network criteria.

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Investigators assessed HRQoL at biopsy and annually for 3 years using validated metrics. Patients completed the EPIC (Expanded Prostate Cancer Index) questionnaire, a PCa-specific instrument that evaluates urinary, sexual, bowel, and hormonal function and bother. They also answered the SF-36, a general health assessment that gauges physical and mental health. 

Except for a slight difference in bowel function at year 1, the investigators found no significant differences in most HRQoL subscales between men on AS and those without PCa over 3 years, even after adjusting for demographic factors. AS patients generally had high HRQoL, in line with previous research. The Finnish arm of the PRIAS (Prostate Cancer Research International Active Surveillance) study, for example, found no significant changes in urinary or erectile function, or mental or physical HRQoL after a year of AS, according to a report in BJU International (2012;109:1614-1619).

It is possible that finer differences in HRQoL existed between the groups that were not captured by the EPIC and SF-36 questionnaires, according to the investigators.

In an editorial comment accompanying the new report, Nachiketh Soodana Prakash, MD, and colleagues at the University of Miami School of Medicine Sylvester Comprehensive Cancer Center stated: “While AS avoids immediate treatment, it is unclear whether it portends any detriment to HRQoL compared to a normal population of similar age men.”

Despite study limitations, Dr Prakash and colleagues wrote that “this study will be helpful to men contemplating AS who are worried about the impact of this decision on HRQoL.”

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1. Pham KN, Cullen J, Hurwitz LM, et al. Prospective Quality of Life in Men Choosing Active Surveillance Compared to Those Biopsied but not Diagnosed with Prostate Cancer. J Urol. August 2016 196,v2;392–398. doi: 10.1016/j.juro.2016.02.2972.

2. Prakash NS, Nahar B, Punenn S. Editorial Comment. J Urol. August 2016 196,v2;98. doi: 10.1016/j.juro.2016.02.2989.

3. Patients with low risk prostate cancer on active surveillance experience good quality of life Elsevier Health Sciences. July 25, 2016. [news release]