Hypothesis / aims of study
Treatment for localized prostate cancer (PCa) is a preference-sensitive decision in which aspects like oncological outcomes and post-PCa treatment generic and prostate-specific quality of life (QoL) should be taken into account. Europa Uomo, representing the voice of European PCa-patients, noticed a gap between the experiences of their members and those reported in the scientific literature. Therefore, they initiated the patient-driven Europa Uomo Patient Reported Outcome Study (EUPROMS) to inform their members about QoL in daily life post-PCa treatment. Here the patient reported outcome (PRO) data on urinary function of men who underwent either single or a combination of two treatments will be presented.
Study design, materials and methods
European PCa patients who were undergoing treatment at the time of survey completion or who underwent PCa treatment in the past, were identified through the network of Europa Uomo and invited to complete a one-time, 20 minute online survey. The survey included demographical questions as well as the language-specific validated EQ-5D-5L measuring generic health, the EORTC-QLQ-C30 measuring cancer-specific QoL and the Expanded Prostate cancer Index Composite short form 26 (EPIC-26) measuring prostate-specific health. The survey was available in 19 languages.
Results
A total of 2943 men from 24 European countries completed the EUPROMS survey. Median age of respondents was 71 years (IQR 65-75) and 82% was living with a spouse. In total, 1937 (65.8%) men underwent a single treatment and 636 (21.6%) underwent two treatments. The median scores for self-reported urinary incontinence show that the impact of treatment is the greatest for men who underwent RP (71, IQR 46-100), a combination of RP and RT (73, IQR 46-94), or a combination of AS and RP (65, IQR 38-92) (Table 1) [1]. Median scores for the self-reported urinary irritable/obstructive subscale are high for all single and combinations of treatments. The individual items that comprise the ‘urinary incontinence’ and ‘urinary irritable/obstructive’ subscales, show differences in how often men leak urine, in how men describe their urinary control status, and in the number of daily pads used to control leakage. With respect to how often men leaked urine over the past four weeks, 73% of men on AS reported ‘rarely or never’ versus 42% of men who underwent RP and 35% for men who underwent AS and RP. About 30% of men who underwent either RP or a combination of RP-RT leaked urine ‘more than once a day’. With the exception of men who underwent RP, RP-RT, or AS-RP, 89.4-92.9% of men who underwent single or a combination of treatments indicated their urinary control could best be described as ‘total control’ or ‘occasional dribbling’. For men who underwent RP, RP-RT, or AS-RP these percentages range from 75.0-82.1%. The percentage of men reporting ‘frequent dribbling’ is higher for AS-RP (16.7%), RP-RT (13.4%), and RP (12.7%). In line with the self-reported control status 76.7-96.6% of men either use ‘no pads’ or ‘1 pad per day’. Men on AS-RP, RP-RT, or RP who reported ‘frequent dribbling’ were more likely to report the use of ‘2 pads per day’ (10.2-11.7%).
Interpretation of results
Data from the EUPROMS study show that RP (either as a single treatment or as a combined treatment) had the greatest negative effect on urinary continence. As indicated above, treatment for PCa is a preference-sensitive decision. Often men are informed about the two most important side-effects, namely sexual dysfunction and urinary incontinence. In [1] it is shown that the effect of PCa treatment on sexual function is not in the same order of magnitude as the here presented data on urinary incontinence. Self-reported sexual dysfunction, and especially erectile dysfunction, is often worse than the level of urinary incontinence.