Associations between prostate cancer-related anxiety and health-related quality of life.

BACKGROUND: There are uncertainties about prostate cancer-related anxiety's (PCRA) associations with health-related quality of life (HRQOL) and major depression, and these could affect the quality of mental healthcare provided to prostate cancer patients. Addressing these uncertainties will provide more insight into PCRA and inform further research on the value of PCRA prevention. The goals of this study were to measure associations between PCRA and HRQOL at domain and subdomain levels, and to evaluate the association between PCRA and probable (ie, predicted major) depression. METHOD: We analyzed secondary cross-sectional data from the North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS-a population-based cohort of prostate cancer patients enrolled shortly after diagnosis [between January 2011 and June 2013] and followed prospectively). Patient-reported measures of PCRA and HRQOL from 1,016 enrollees who participated in NC ProCESS's 1-year follow-up survey were assessed. Outcomes of interests were a) linear correlations between contemporaneous memorial anxiety scale for prostate cancer (MAX-PC) and Short Form 12 (SF-12) scores, and b) measures of association between indicators of clinically significant PCRA (ie, MAX-PC > 27) and probable depression during survey contact (ie, SF-12 mental component score ≤43). RESULTS: PCRA measures had notable associations with SF-12's mental health subscale (assesses low mood/nervousness [rho = -0.42]) and emotional role functioning subscale (assesses subjective productivity loss [rho = -0.46]). Additionally, the risk of probable depression was significantly higher in participants with clinically significant PCRA compared with those without it (weighed risk ratio = 5.3, 95% confidence interval 3.6-7.8; P < .001). CONCLUSION: Prostate cancer patients with clinically significant PCRA should be assessed for major depression and productivity loss.

Patient-reported Quality of Life Following Stereotactic Body Radiotherapy and Conventionally Fractionated External Beam Radiotherapy Compared with Active Surveillance Among Men with Localized Prostate Cancer.

BACKGROUND: Evidence supporting the efficacy of stereotactic body radiotherapy (SBRT) for localized prostate cancer is accumulating, but comparative studies of patient-reported quality of life (QOL) following SBRT versus conventionally fractionated external beam radiotherapy (EBRT) or active surveillance (AS) are limited. OBJECTIVE: To compare QOL of patients pursuing SBRT and EBRT versus AS. DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort of 680 men with newly diagnosed localized prostate cancer was prospectively enrolled from 2011 to 2013. INTERVENTION: SBRT, EBRT without androgen deprivation therapy, or AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: QOL was prospectively assessed before treatment (baseline), and at 3, 12, and 24mo after treatment using the validated Prostate Cancer Symptom Indices, which contain four domains: sexual dysfunction, urinary obstruction/irritation, urinary incontinence, and bowel problems. Propensity weighting via logistic regression models was used to balance baseline characteristics, and the mean QOL scores of EBRT and SBRT patients were compared against AS patients as the control group. RESULTS AND LIMITATIONS: Compared with AS patients, EBRT patients had worse urinary obstructive/irritative symptoms and sexual dysfunction at 3mo, and worse bowel symptoms at 3 and 24mo. SBRT patients had similar scores as AS patients in all domains and across all time points; however, due to small sample size, worse sexual function and urinary incontinence in SBRT patients cannot be ruled out. Further research is needed to assess long-term outcomes. CONCLUSIONS: In a nonrandomized cohort of men with localized prostate cancer, SBRT appeared to result in favorable QOL results through 2yr of follow-up, but worse sexual function and urinary incontinence compared with AS cannot be ruled out completely. Larger studies with longer follow-up are needed to confirm these findings. PATIENT SUMMARY: Stereotactic body radiotherapy (SBRT) and active surveillance appear to have similar quality of life outcomes through 2yr, although worse sexual function and urinary incontinence from SBRT cannot be ruled out completely.

Patterns of Care of Node-Positive Prostate Cancer Patients Across the United States: A National Cancer Data Base Analysis.

BACKGROUND: Twelve percent of newly diagnosed prostate cancers in the United States are node-positive. In a setting of disparate treatment guideline recommendations for node-positive disease, this study describes the treatment patterns for clinical node-positive (cN+) and pathologic node-positive (pN+) patients across the United States. MATERIALS AND METHODS: Using the National Cancer Data Base, men diagnosed with cN+ or pN+ disease were identified from 2006 to 2011. For each cohort, the proportion of patients who received radiotherapy (RT), androgen deprivation therapy (ADT), and other treatments was analyzed. Multivariable logistic regression models were used to examine patient and clinical factors associated with use of definitive treatment (RT or prostatectomy) in cN+ patients, and postprostatectomy RT in pN+ patients. RESULTS: A total of 8464 cN+ and 4890 pN+ patients were identified. For cN+ disease, ADT alone was the most common treatment used (3892 patients, 46.0%) followed by RT with or without ADT (2657 patients, 31.4%). Men with older age, higher prostate-specific antigen at diagnosis, or higher biopsy Gleason score were less likely to receive curative treatment (RT or prostatectomy), whereas those with higher clinical T stage were more likely. For pN+ disease, 2948 patients (60.3%) received no adjuvant treatment and 833 patients (17.0%) received RT following prostatectomy. Patients with older age, negative margin, and comorbidities were less likely to undergo RT after prostatectomy, whereas those with higher pathologic T-stage were more likely. CONCLUSION: Many patients with cN+ or pN+ prostate cancer do not receive RT, despite the possibility of long-term control and cure. Randomized trials are needed to guide treatment decisions in this patient population.