Health‐related quality of life and satisfaction with care among older men treated for prostate cancer with either radical prostatectomy or external beam radiation therapy

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Abstract
OBJECTIVE To analyse health‐related quality of life (HRQoL) and satisfaction with care across potential curative treatments for older patients newly diagnosed with prostate cancer. PATIENTS AND METHODS In a prospective cohort study we recruited 115 older patients (≥65 years) newly diagnosed with prostate cancer from the urology clinics of an urban academic and a Veterans’ Administration (VA) hospital. Patients completed generic (Short Form‐36), prostate‐specific (University of California Los Angeles Prostate Cancer Index) HRQoL, and Client Satisfaction with Care (CSQ‐8) surveys before treatment with either radical prostatectomy (RP) or external beam irradiation (EBRT) and at 3, 6 and 12 months afterward. Clinical and demographic data were obtained via medical chart review. A repeated‐measures analysis of variance was used to examine changes in generic and prostate cancer‐specific HRQoL between treatments. Log‐linear regression was used to analyse the factors associated with 12‐month HRQoL scores, and Kaplan–Meier survival curves were used to compare the return to baseline values for HRQoL. RESULTS The RP group had significantly higher income, education and better general health than the EBRT group. Age (odds ratio 0.5, 95% confidence interval 0.32–0.82), non‐VA hospital (28.8, 2–402) and prostate‐specific antigen level at diagnosis (2.8, 1.05–7.5) were associated with RP. The analysis results indicated that the RP group had higher scores for generic HRQoL subscales of physical function (P = 0.019), role emotional (P = 0.037), vitality (P = 0.033) and general health (P = 0.05) than the EBRT group. A log‐linear regression model for predicting the 12‐month scores showed that RP was associated with higher scores for most of the generic HRQoL and bowel function (odds ratio 1.12, P = 0.03), urinary bother (1.6, P = 0.014) and bowel bother (1.5, P = 0.013). Being older was associated with a lower score on bowel function (0.98, P = 0.05) and sexual function (0.92, P = 0.05). Satisfaction with care was comparable between treatment groups at baseline and at the follow‐up. CONCLUSIONS Older patients tolerate RP well from the HRQoL perspective and thus decisions for therapy in this age cohort should not be based primarily on age.