Quality of life following definitive therapy for localized prostate cancer: potential impact of multiple therapies

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Abstract
Patients with clinically localized prostate cancer often undergo multiple therapies during their disease trajectory, either as planned combinations or as salvage for recurrence. Most studies of health-related quality of life in men with prostate cancer have focused on those receiving one modality or another. This review summarizes the little that is known about health-related quality of life after multiple therapies. Twelve articles are reviewed. One is more of historical interest at this time and sets the stage for the great prevalence of combination therapy with androgen ablation in men undergoing pelvic irradiation. Six deal with brachytherapy combined with external beam radiation therapy, androgen ablation, or both. Three address androgen ablation or radiation for biochemical recurrence. One presents outcomes following salvage radiation, and one summarizes results from patients undergoing salvage radiation or prostatectomy following primary treatment with the other. Combination therapy for early stage prostate cancer confers many additional decrements in health-related quality of life that must be considered when making treatment decisions, especially given the minimal differences in survival between various approaches.