Presentation Authors: Christopher C. Randall*, Mohamed H. Kamel, Mahmoud I. Khalil, L Joseph Su, Rodney Davis, Little Rock, AR
Introduction: Active surveillance (AS) or definitive treatment (DT) in the form of surgery and radiation are treatment options for low risk prostate cancer (Pca). However, quality of life (QoL) outcomes of these options are poorly understood. We aim to study the QoL in low risk Pca patients who chose AS compared to DT using the Veterans RAND-12Â® (VR-12) QoL health survey.
Methods: Low-risk Pca patients were identified through the Arkansas Central Cancer Registry. VR-12 health surveys were mailed to qualifying patients with follow-up phone calls to non-responders. The mental component score (MCS) and physical component score (PCS) together with the four distinct sub-scores of both MCS and PCS were analyzed and compared between the two groups. Supplementary questions were also administered in addition to the VR-12 survey including: age at diagnosis, education level, level of Urologist trust, and patient inclusion in the treatment decision. A multivariate regression model adjusted for these variables was performed to analyze potential effects on mental or physical health outcomes.
Results: Surveys were mailed to 370 patients and 137 (37%) responded. 4 respondents received hormonal treatment and were excluded from analysis. Of the remaining 133 respondents; 40 received AS and 93 received DT (surgery n=63 and radiation n=30). The mean MCS in AS and DT was 54 (SDÂ±10.42) and 52 (SDÂ±8.86) respectively (p=0.39). The mean PCS in AS and DT was 49 (SDÂ±8.66) and 43 (SDÂ±12.52) respectively (p=0.001). In the multivariate analysis, AS group did not have improved mental QoL (OR=2.22, 95% CI = 0.74-6.64) compared to the DT group. However, AS patients were 12 times more likely to report better physical QoL (OR = 12.53, 95% CI = 2.39-65.69) than the DT group. The AS group outscored the DT group in all four PCS sub-scores: general health (p=0.002), physical functioning (moderate activities (p=0.04) and climbing stairs (p=0.06)), role limitation (accomplished less (p=0.003) and limited in activities (p=0.05)), and pain (p=0.11). AS group also shows higher scores in MCS sub-scores but without statistical significance with the exception of vitality (p=0.01).
Conclusions: Our results demonstrate that low risk Pca patients who choose AS to be their primary treatment have similar mental QoL outcomes as those patients electing for DT. However, the physical QoL for the AS patients far exceeds that of those who elected for DT. This is likely due to the absence of treatment complications in the AS group. Further analysis of our results continued to demonstrate the better QoL outcomes in the low risk Pca patient electing for AS.