More men than expected experience significant urinary incontinence and erectile dysfunction following prostate cancer (PCa) treatment, according to results of a new international survey presented at the European Association of Urology 2020 virtual congress.
The Europa Uomo Patient Reported Outcomes Study (EUPROMS) included 2943 European men (mean age 70 years and mean age at diagnosis 64 years) from 25 countries treated for PCa. Patients responded online to the Expanded Prostate Cancer Index Composite (EPIC-26), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC-QLQ-C30), and EQ-5D-5L. Two-thirds of patients underwent 1 PCa treatment and 22%, 10%, and 2% had 2, 3, or 4 or more treatments, respectively.
Half of patients reported that loss of sexual function (including the ability to have an erection or reach orgasm) was a “big” (28%) or “moderate” (22%) problem for them; 82% were currently living with a partner. Chemotherapy, radiation therapy, and radical prostatectomy (RP) were each increasingly associated with severe loss of sexual function (scores 12 vs 17 vs 21, respectively, on the EPIC-26).
Respondents scored their sexual function much lower than patients in clinical studies, André Deschamps, MD, chair of Europa Uomo in Antwerp, Belgium, revealed in a virtual presentation. Active surveillance was associated with better sexual function and RP and RT with worse sexual function among survey respondents than trial patients.
Urinary incontinence was worst in patients managed with RP. Compared with surgery, radiation therapy doubled and chemotherapy tripled fatigue scores (score 11 vs 22 vs 33, respectively, on the EORTC-QLQ-C30). Overall, chemotherapy was associated with the worst health-relatedquality of life (QoL) scores.
Self-reported QoL scores are best when PCa is discovered in an early, curable stage, Dr Deschamps stated. Thus, efforts aimed at early detection and awareness are essential to avoid unnecessary deterioration in QoL.
“Quality of life is negatively impacted by any treatment of prostate cancer other than active surveillance,” he said. “Hence, active surveillance should be promoted as the first option for treatment for those men where it can be offered safely.”
Dr Deschamps added, “We hope that these results will be used to establish and disseminate realistic expectations of the effects of the different treatments for prostate cancer on QoL.”
“This is a valuable survey, the largest of its kind ever undertaken,” Arnulf Stenzl, MD, of Tübingen University in Germany commented in a news release. “It uses the same questionnaires used in standard clinical settings, but it is both qualitatively and quantitatively different to the kind of study usually undertaken, so it needs to be read alongside these previous studies. It has several strong points, not least that this is multi-national, and so will reflect the impact of treatment on a wide range of patients, with different health systems.”
The study did not assess responses according to tumor characteristics, comorbidities and/or age, which is a limitation.
Disclosure: This clinical trial was supported by Bayer, Ipsen, and Janssen. Please see the original reference for a full list of authors’ disclosures.
Deschamps A. The real effect of prostate cancer treatment: EUPROMS study first patient driven quality of life study ever [webcast]. Presented at: EAU20 Virtual Congress; July 17 to 19, 2020.
Largest-ever study by patients shows prostate cancer treatment has significant impact on quality of life [press release]. Amsterdam, The Netherlands. Europa Uomo & European Association of Urology congress; July 18, 2020.