The ProCaSP Study

Quality of Life Outcomes of Prostate Cancer Patients After Radiotherapy or Radical Prostatectomy in a Cohort Study

Nora Eisemann; Sandra Nolte; Maike Schnoor; Alexander Katalinic; Volker Rohde; Annika Waldmann


BMC Urol. 2015;15(28) 

In This Article


Prostate cancer has a very long period of latency of up to 15–20 years during which the disease is histologically present but has not yet become symptomatic. Autopsy studies have shown that a relevant proportion of men – depending on age and on ethnicity up to 83% (US whites, age group 71–80 years) – has an occult prostate cancer.[1,2]

Despite the conflicting evidence of benefits and harms of PSA screening[3,4] and no coverage of costs by statutory health insurance in Germany, testing on patient request is common practice (approx. 30% per year in men aged 45+).[5] With the increasing use of PSA testing it can be assumed that nowadays a relevant proportion of former asymptomatic, occult cancer will be diagnosed. Today, prostate cancer is the most common malignancy in men in Germany with about 65,000 incident cases each year and a five-year prevalence of about 280,000 men.[6]

As every screening test, including the PSA test, aims to detect occult cancers at an early stage, one can assume that a relevant proportion of screening detected prostate cancers would not have become symptomatic during life time and thus can be regarded as overdiagnosis. In these patients cancer treatment may have no benefit but may result in treatment associated morbidity.[7] As there is a moral imperative for treatment of cancer patients independent of tumour size, most young to middle-aged patients with non-metastatic prostate cancer receive some kind of invasive treatment. The main therapeutic strategies are radical prostatectomy (RP), external radiation, and interstitial brachytherapy. Each of above therapies can achieve a five-year cancer-specific survival of more than 90%.[8] Because of the favourable prognosis of early stage tumours and because of treatment morbidity, outcomes other than 'survival' are increasingly important.[9]

As a result, many studies focus on middle-term or long-term health-related quality of life (HRQOL) outcomes. For example, non-nerve-sparing RP (nnsRP) has been shown to lead to a higher rate of incontinence and impotence. Nerve-sparing RP (nsRP) has been reported to have a positive impact on postoperative incontinence and impotence,[10,11] and is preferred whenever possible. Examples of side effects of radiotherapy (RT) include irritable urinary and bowel problems, i.e. symptoms that can fundamentally compromise patients' overall well-being.[12–14] While it is desirable to detect early stages of prostate cancer and thus lower mortality rates of prostate cancer, these therapies can have substantial impact on the HRQOL of cancer patients.

In view of the high proportion of overdiagnosis in prostate cancer[15–17] and while there is 'no optimal way to treat localised prostate cancer',[18] the pros and cons of the available treatment options must be considered. The ProCaSP Study was an observational study aimed at comparing longitudinal HRQOL outcomes across a range of treatment groups for localised prostate cancer in real-world treatment situations. In detail, it was aimed at exploring inter-group differences between two prostatectomy and three radiotherapy groups: 1) nerve-sparing RP, 2) non-nerve-sparing RP, 3) brachytherapy (brachyRT), 4) external RT (externRT), and 5) combined external and brachytherapy (combRT). In addition, HRQOL of the cancer patients was compared to a reference population.