Long-term Survivors, localised treatment & QoL.

[pjoshea13]

New German study.

I expect that not many of us who started out with localized PCa were worrying about quality of life [QoL] ten or more years out. I know that I was more concerned about the immediate five years.

"Several therapies for localised prostate cancer (PC) are available; all yield similar survival rates. However, each therapy has significant side effects that can influence patients' health-related quality of life (HRQoL) in the long run."

"Long-term localised PC survivors formerly treated with a combination of RP {radical prostatectomy} and RT {radiotherapy} or with ADT {androgen deprivation therapy} report poorer HRQoL {health-related quality of life} and more symptoms than patients treated with either RP or RT alone."

-Patrick

ncbi.nlm.nih.gov/pubmed/310...

Eur J Cancer Care (Engl). 2019 May 2:e13076. doi: 10.1111/ecc.13076. [Epub ahead of print]

Health-related quality of life in long-term survivors with localised prostate cancer by therapy-Results from a population-based study.

Adam S1,2, Koch-Gallenkamp L3, Bertram H4, Eberle A5, Holleczek B6, Pritzkuleit R7, Waldeyer-Sauerland M8, Waldmann A8,9, Zeissig SR10, Rohrmann S2, Brenner H3,11,12, Arndt V1.

Author information

1

Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.

2

Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

3

Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.

4

Cancer Registry of North Rhine-Westphalia, Bochum, Germany.

5

Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.

6

Saarland Cancer Registry, Saarbrücken, Germany.

7

Schleswig-Holstein Cancer Registry, Lübeck, Germany.

8

Hamburg Cancer Registry, Hamburg, Germany.

9

Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany.

10

Cancer Registry of Rhineland-Palatinate, Mainz, Germany.

11

Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.

12

German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.

Abstract

OBJECTIVE:

Several therapies for localised prostate cancer (PC) are available; all yield similar survival rates. However, each therapy has significant side effects that can influence patients' health-related quality of life (HRQoL) in the long run.

METHODS:

The study sample included 911 survivors with localised PC, 5-15 years post-diagnosis who were identified from the population-based CAESAR + study in Germany. HRQoL was assessed using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. The association between type of therapy and HRQoL was assessed with multivariable linear regression and global F-test adjusting for age, time since diagnosis and comorbidities.

RESULTS:

Overall, survivors treated with radical prostatectomy (RP) or radiotherapy (RT) alone reported the best HRQoL and the lowest symptom burden. Conversely, survivors treated with androgen deprivation therapy (ADT) (& RP/RT) or RP & RT (in combination) reported the worst HRQoL and the highest symptom burden. Significant differences among treatment groups in HRQoL were found for global health status (p = 0.041), social functioning (p = 0.007), urinary symptoms (p = 0.035), bowel symptoms (p = 0.017) and hormonal treatment-related symptoms (p < 0.001) among other symptoms.

CONCLUSIONS:

Long-term localised PC survivors formerly treated with a combination of RP and RT or with ADT report poorer HRQoL and more symptoms than patients treated with either RP or RT alone.

© 2019 John Wiley & Sons Ltd.

KEYWORDS:

health-related quality of life; prostate cancer; therapy; well-being

PMID: 31050091 DOI: 10.1111/ecc.13076

[NPfisherman]

Thanks for posting....it will be interesting to see how Tookad and other newer tx will change the playing field and QOL...

Fish

[Ralph1966]

Is this iclude 6 months (temporary) ADT with SRT following BCR (recurrence) post RRP?

[pjoshea13 in reply to Ralph1966]

Ralph,

I can't tell.

A prostatectomy + salvage radiation (my experience too) already puts you in the "poorer HRQoL" category.

But at 15 years, I'm not complaining. Perhaps my 56-year-old self would not have been happy trying out my 71-year-old body, but it's not too bad.

-Patrick

[MJCA]

I started my journey 13.5 years ago. ADT, brachytherapy and radiation. NOW on Lupron AND Erleada AND Xgeva. Just recently I have been SO fatigued. The depression this round has been bad. I am nauseous most of the time. I weighed 145, now down to 137. I love to travel and have no desire to do anything. It sucks big time since I am only 59.

[BrentW in reply to MJCA]

My journey started 15 years ago, when I was 44, with brachytherapy, salvage LRP, and copious ADT. Currently on Zytiga. I had to quit my job because I felt crap for much of the day, and have lost my creativity (I used to write for fun); but I have managed to hold on to doing some palaeontological research -- mostly microscopic stuff that I can start and stop as I wish. It is, in my view, of paramount importance that one finds something one loves to do that is within one's current range of capabilities, as it can be so uplifting. But pace yourself and accept that there will be slower days and no-go days. I am hoping for many more years, as there are still things I dream realistically of doing. I hope the same applies to you.

[mcp1941 in reply to MJCA]

I started 23 years ago and had the same primary treatment and now on Eligard and Erleada. HT is failing. 4 PSA increases in a row. PSA 2.4. I am a lot heavier then you. Started Erleada at 245 now 237 and holding. I just had my first visit with a clinical social worker for depression and will see her again on Friday. Most likely will start on Zoloft. I was taking Zoloft for a year during my primary treatment 23 years ago and within 2 weeks I was a new man. Don't put off treatment for depression!

Wishing you the best

Mike P

[MJCA in reply to mcp1941]

I hear ya. I have been on Wellbutrin and Cymbalta. I do see a therapist. If I cannot deal with something on my own I seek assistance. I also attend a monthly support group.

[monte1111 in reply to MJCA]

I used to weigh 145. Dropped into 130's when this journey began, which set off alarm bells and I even bought a weight scale. I am now 165 plus after 2 years. One month 173. Mostly my huge Homer Simpson belly. Kinda funny. Took cancer to make me look like I didn't have cancer. I am now weening off of prednisone and have found fatigue increase and loss of appetite. Hoping I can turn myself around. I wouldn't worry about any diet taboos for now. I will be burnt at the stake, but perfect ice cream weather. An ounce of cheese has more calories than an ounce of honey. I often have a chunk of sharp cheddar cheese and the saltiest saltine crackers I can find. Helps with sore throat side effects of drugs I take. You might try that for nausea and to help with weight gain. Be sure doctor is aware of weight loss. My MO noted my weight loss and I must have looked like hell. Perhaps the reason she prescribed prednisone? Good luck.

[Schwah]

So sorry to hear that. If you can find the energy to excercise it should definitely help the energy level and most likely the depression. Tough cycle. Too Tired and to decreased to work out so get more tired and depressed. Hopefully you can find a way to break the cycle .

Schwah

[Mish80]

Thank you for that. My dad only had a RP 9 years ago but I have always wondered if he should have had salvage radiation also... who knows. We don’t have the luxury of hindsight in this life. He has had 9 years free if any treatment and the side effects from that so quality of life I guess....

[Tommyj2]

I'm finding these results a little difficult to interpret... appear to be saying that survival is similiar whether treated with RP, RT alone or RP,RT with ancillary Tx ( notably ADT).. if this is so why would anyone opt for the additional Tx?? After initial failure I can understand but if stats are the same with initial treatment it would make little sense....

[jedgar1]

Gee what a surprise, people who just had a Rp or RT and didn't need further treatment did better than people who are still treating their cancer after 3 or 4 different treatments and are still are on lupron.