COMMENTARY

Patient QoL: More Proof That PCa Surveillance Is a 'Reasonable Approach'

Gerald Chodak, MD

Disclosures

April 26, 2016

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Hello. I am Dr Gerald Chodak for Medscape. Today I want to talk about the impact of active surveillance on men's quality of life. At the European Association of Urology meeting in Munich, Venderbos and colleagues[1] presented data on 427 men who had received either radical prostatectomy, radiation therapy, or active surveillance. They used several validated questionnaires to survey patients who had been treated somewhere between 5 and 10 years previously, and they included a group of men who had no prostate cancer. What they found is not surprising, namely that men who had active surveillance had better urinary control and better sexual function than either group having radical prostatectomy or external radiation.

What is somewhat unique about this study is that they compared the four different groups—including men who did not have prostate cancer—and, interestingly, the men on active surveillance had a similar quality of life compared with those who didn't have prostate cancer at all.

Now, there are some shortcomings to this trial. Number one, they did a one-time questionnaire at various times after patients were enrolled in the various treatments. It is possible that with different time periods and different assessments, some of the results may be different. But the overall differences were quite striking.

Another point is that more than 600 men were approached, so their compliance rate was somewhere in the 65%-70% range. It is also possible that some bias exists by the people not completing the surveys. But at least in the different groups, the response rates were somewhat similar.

What does this mean going forward? First of all, it gives us added information to tell patients about what they can expect if they choose active surveillance as their management. Interestingly, this was done several years after therapy, not just immediately thereafter. Many of the men were able to endure the psychosocial issues associated with not getting immediate treatment, and that did not adversely affect their quality of life.

The bottom line here is that we have growing information that active surveillance is a reasonable approach; it offers men a good quality of life. It certainly should be explained to them in a way that allows them to make an informed choice about whether they want to take on the associated risks of that therapy or instead endure the risk of impotence, incontinence, or other complications associated with treatment such as surgery or radiation.

I look forward to your comments. Thank you.

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