Changes in Continence and Health-Related Quality of Life After Curative Treatment and Watchful Waiting of Prostate Cancer

ObjectivesTo investigate the long-term changes in health-related quality of life (HRQOL), continence, and sexual function after curative therapy (CT) and watchful waiting (WW) for prostate cancer.MethodsA self-reported questionnaire of HRQOL and continence was administered to patients with prostate cancer who were candidates for CT and WW. The questionnaire was re-administered during follow-up. The pretreatment and posttreatment HRQOL burden scores were compared and correlated with the treatment, continence, and sexual function.ResultsOf the 61 patients, 41 chose CT (26 chose prostatectomy and 15 radiotherapy). The average follow-up for the CT patients was 24.3 ± 13.3 months. The pretreatment incontinence score was 0.38 ± 0.9 and the HRQOL burden score was 16.3 ± 8.8 (CT versus WW, P = 0.55). On follow-up, 23 (56%) of 41 CT patients were continent. The HRQOL burden score after treatment was similar between the CT and WW patients (20.4 ± 9.6 versus 18.4 ± 9.0, P = 0.45). The continent patients had a significantly lower HRQOL burden compared with the post-CT incontinent patients (17.41 ± 7.4 versus 24.2 ± 10.8, P = 0.02). The HRQOL burden score after treatment for CT patients who maintained sexual activity and CT patients who lost their sexual activity was similar (P = 0.28).ConclusionsThe HRQOL after CT of prostate cancer was related to patients’ self-perception of continence. Incontinence, either urinary or fecal, was associated with an increased self-reported HRQOL burden, although reduced sexual function was not associated with such a change. The WW patients maintain their HRQOL. Separating the continent and incontinent patients during the analysis of the posttreatment HRQOL brought to light the adverse outcomes associated with post-CT incontinence.