Prospective Long-term Health-related Quality of Life Outcomes After Surgery, Radiotherapy, or Active Surveillance for Localized Prostate Cancer

We prospectively evaluated long-term health-related quality of life (HRQoL) in a large US patient population treated for localized prostate cancer. HRQoL outcomes varied according to treatment modality and time. Radical prostatectomy (RP) results in worse long-term urinary function and incontinence, but less irritative and obstructive symptoms than external beam radiotherapy (EBRT) and active surveillance (AS). Sexual domain scores were least affected by AS, while RP shows similar scores to EBRT at long term. These changes should inform patients about their expected outcomes following treatment. Localized prostate cancer (PCa) treatment is associated with reduced health-related quality of life (HRQoL). Current literature is limited by short-term follow-up. To prospectively evaluate the 5-yr HRQoL outcomes in men undergoing radical prostatectomy (RP), external beam radiotherapy (EBRT), or active surveillance (AS). We prospectively evaluated HRQoL in patients with low-risk/favorable intermediate-risk PCa enrolled in the Center for Prostate Disease Research multicenter database between 2007 and 2017. Of 1012 patients included in the study, 252 (24.9%) underwent AS, 557 (55.0%) RP, and 203 (20.0%) EBRT. Patients complete the Expanded Prostate Cancer Index Composite and the 36-item Medical Outcomes Study Short Form at baseline and thereafter each year up to 5 yr after treatment. Temporal changes in HRQoL were compared between treatments and were modeled using linear regression models adjusted for baseline HRQoL, demographic, and clinical characteristics. RP showed the least irritative symptoms and worse incontinence in comparison with AS (p