ABSTRACT
The physician’s primary responsibility in caring for a patient with prostate cancer is to address the patient’s concerns regarding treatment and prognosis. Currently, the most common therapeutic options for localized prostate cancer are radical prostatectomy, external radiation, and interstitial brachytherapy. Each of these interventions has undergone significant refinement in the past 10 years and can independently achieve higher than 95% cancer-specific survival at 5 years following primary treatment.1-6 Therefore, the vast majority of patients with prostate cancer can anticipate post-therapy survival that is measured in years or even decades and, in many cases, prostate cancer can reasonably be characterized as a “chronic” disease of aging.7 As with most chronic diseases, health-related quality of life (HRQOL) is often a primary concern for the patient and, as a result, there is now an increased emphasis on the importance of HRQOL outcomes after prostate cancer therapy. Indeed, the use of HRQOL endpoints is now commonplace in prostate cancer trials and research, and clinicians often identify HRQOL outcomes as a means for distinguishing between treatment options that are generally equivalent with regard to cancer control.8-13 To date, studies of prostate cancer HRQOL have focused on two distinct, but complementary, priorities: 1) developing and utilizing validated instruments to more precisely and reliably characterize the prevalence and severity of adverse urinary, sexual, and bowel HRQOL effects after prostate cancer treatment; and 2) establishing patient-, rather than physician-, report data as the standard methodology for characterizing the HRQOL effects of prostate cancer and its treatment.10,14-16
Available instruments for measuring HRQOL among prostate cancer survivors, as well as their relative merits and pitfalls, are described in Chapter 69. The aim of this chapter is to review several “state of the art” concepts underlying the assessment of HRQOL and to summarize the contemporary literature that examines and compares patient-report HRQOL changes and outcomes following contemporary therapies for localized prostate cancer (e.g. radical prostatectomy, external beam radiation therapy, and brachytherapy), with emphasis on knowledge gained from studies that employ one or more validated HRQOL instruments.
