Recovery of health related quality of life in the year after radical prostatectomy: early experience.

PURPOSE: We determined the temporal course of patient return to baseline quality of life after treatment with radical prostatectomy for early stage prostate cancer. MATERIALS AND METHODS: After establishing a longitudinal observational database of men undergoing radical retropubic prostatectomy we used established, validated quality of life questionnaires (RAND 36-Item Health Survey and University of California, Los Angeles Prostate Cancer Index) to document changes in general and disease specific health related quality of life (HRQOL). We assessed 90 patients at baseline before surgery and then at 3-month intervals for 1 year postoperatively. Logistic regression was used to explore predictors of the return to baseline. RESULTS: After prostatectomy patients had a significant decrease in all domains of HRQOL. Return to baseline was rapid in the general and bowel domains with at least two-thirds to three-fourths of patients reaching pretreatment levels within 6 months of surgery. Return to baseline was slower in the urinary and sexual function domains with 61 and 31% of the men, respectively, reaching pretreatment levels by 1 year after surgery. Of those who reached baseline the average intervals for the bowel, sexual and urinary domains were 5, 6 and 7 months, respectively. Married and white patients were more likely to achieve a return to baseline HRQOL during year 1 postoperatively. However, education level was inversely associated with the likelihood of returning to baseline. CONCLUSIONS: During the year after radical prostatectomy for early stage prostate cancer patient quality of life steadily improved. By 3 months postoperatively 30 to 40% of the patients had already recovered baseline levels of physical, mental and social functioning, and by 6 months more than 70% had reached baseline in the general HRQOL domains. By 12 months after surgery 86 to 97% of the patients had returned to baseline levels in each domain. Each domain continued to improve throughout the year. For the patients who reached baseline general HRQOL during followup average recovery time was 5 to 6 months.

Quality-of-life outcomes in long-term survivors of advanced prostate cancer.

The authors evaluate the temporal progression of health-related quality of life (HRQOL) in men treated hormonally with surgical or medical castration, as well as to see if either treatment would be associated with a greater impact on patients' quality of life. The authors assessed general and prostate-targeted HRQOL with two self-administered, validated instruments (the RAND 36-Item Health Survey and the UCLA Prostate Cancer Index) in a longitudinal, observational study of 63 men newly diagnosed with metastatic prostate cancer and treated with bilateral orchiectomy or combined androgen blockade with leuprolide and flutamide. Patients completed the two HRQOL instruments by mail at baseline and at 3- and 6-month intervals after initiation of treatment. Significant improvements were demonstrated in 10 of 14 HRQOL domains for all men during the first 12 months. These include all eight of the general HRQOL domains and the disease-specific domains that address bowel function. The authors identified no differences in any of the general or prostate-targeted HRQOL domains when comparing men who underwent orchiectomy versus combined androgen blockade. Patients with metastatic prostate cancer can be informed that general and prostate-specific HRQOL will be similar, regardless of whether they choose medical or surgical castration, and that health status will likely remain stable or improve during the initial months of treatment. Physicians must make patients aware of both the quantity and quality of life they can expect with advanced prostate cancer, and must actively involve them in their treatment decisions.

Patient satisfaction with short stays for radical prostatectomy.

OBJECTIVES: We evaluated the effects on patient satisfaction of shortened postoperative hospital stays after radical retropubic prostatectomy (RRP). METHODS: A previously validated, self-administered instrument was used to assess satisfaction with care in a retrospective, cross-sectional study of 129 men who had undergone RRP after implementation of a short-stay clinical care pathway. Health-related quality of life outcomes, comorbidity, and sociodemographic data were also measured with established instruments. RESULTS: Satisfaction with care was uniformly high and did not vary with length of stay (LOS), time since surgery, or health-related quality of life. CONCLUSIONS: Decreased LOS mandated by the need for a cost-efficiency path does not adversely affect patient satisfaction.