Institut Paoli-Calmettes, Marseille, France
G Raldine Pignot , Rajae Touzani , Anne Deborah Bouhnik , Patricia Marino , Jochen Walz , Stanislas Rybikowski , Naji Salem , Slimane Dermeche , Gwenaelle Gravis , Marc Karim Bendiane
Background: Several treatment options are available for prostate cancer (PC) with different functional side effects. The aim of our study was to assess the long-term consequences of the therapeutic strategies on continence, sexual function and quality of life (QOL) for men with a diagnosis of PC from the 5-year VICAN survey. Methods: The VICAN survey consisted in a French representative sample of 4174 5-years cancer survivors. Self-reported data were collected through telephone interviews. The questionnaire aimed to document the living conditions and quality-of-life (using the SF-12 questionnaire) of cancer survivors, including treatments’ side-effects. Results: 447 out of 4174 survivors had PC, median age 71 [57-86] years. Strategies included: radical prostatectomy alone (RP) (42.8%) or with salvage radiotherapy (RP+RT) (7.5%), radiotherapy alone (RT) (17.5%) or in association with hormonal therapy (RT+HT) (11.6%), surveillance (17.4%), and hormonotherapy alone (HT) (3.2%). A total of 51.5% of patients had urinary leakage (sometimes 36.2%, often 12.3%, or very often 3.0%), with a significant impact on physical and mental QOL, and perceived discrimination (p = 0.049, p = 0.020, and p = 0.025, respectively). Patients treated with RP had significantly more urinary leakage than other strategies (59.0% versus 36.6% for RT, and 47.3% for RT+HT, p = 0.026). Among 380 pts assessable for sexual function, 56.0% reported dysfunction, with a significant difference to the detriment of RP+RT (74.1% versus 63.5% for RP, 48.6% for RT, 58.2% for RT+HT, 43.4% for HT and 37.8% for surveillance, p = 0.004). More significant decrease in the number of sexual intercourse (70.6%) and libido (74.6%) were reported in case of HT (p = 0.035), with a significant impact on depressive symptoms, physical and mental QOL (p = 0.002, p < 0.001, and p = 0.002). Conclusions: Self-assessed functional outcomes 5 years after PC diagnosis remain poor, specifically for continence after RP and sexual dysfunction after HT, with a significant impact on QOL. Implementation of new long-term management strategies for these patients is required to improve their urinary, sexual function and QOL.
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