Abstract
Objectives
To investigate impact of age and race on health-related quality of life (HRQoL) in
men undergoing radical prostatectomy (RP) using a prospectively maintained, racially
diverse cohort.
Methods
The Center for Prostate Disease Research Multicenter National Database was used to
identify patients receiving RP from 2007-2017. The Expanded PCa Index Composite and
36 Item Short-Form Health Survey were completed at baseline and regular intervals.
Groups were stratified based on age: <60, 60-70, >70. Longitudinal patterns in HRQoL
were assessed using linear regression models, adjusting for baseline HRQoL, demographics,
and clinical characteristics.
Results
In 626 patients undergoing RP, 278 (44.4%) were <60, 291 (46.5%) were 60-70, 57 (9.1%)
were >70. Older men had worse baseline urinary bother (P<.01) and sexual HRQoL (P<.01). Baseline urinary function was similar for older and younger men. Post-RP urinary
and sexual HRQoL was significantly lower in men >70. However, when adjusting for baseline
HRQoL, race, NCCN risk, and comorbidities, no difference was found between age groups
in urinary function or bother, or sexual function. Sexual bother was worse in older
men until 48 months post-operatively but subsequently improved to levels similar to
younger patients. Race independently affected HRQoL outcomes with older African American
men reporting worse urinary function and sexual bother.
Conclusions
When accounting for baseline HRQoL, age does not independently predict worse HRQoL
outcomes. Older and younger men experience similar declines in urinary and sexual
domain scores after RP. Our findings may be used to better inform patients regarding
their expected post RP HRQoL and guide treatment decision-making.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Cancer of the prostate - cancer stat facts. SEER. Accessed July 15, 2019. https://seer.cancer.gov/statfacts/html/prost.html
NCCN - evidence-based cancer guidelines, oncology drug compendium, oncology continuing medical education. Accessed December 9, 2020. https://www.nccn.org/
- Impact of age at diagnosis on prostate cancer treatment and survival.J Clin Oncol. 2011; 29: 235-241https://doi.org/10.1200/JCO.2010.30.2075
- Robot-assisted radical prostatectomy in men aged >or =70 years.BJU Int. 2009; 104: 1492-1495https://doi.org/10.1111/j.1464-410X.2009.08718.x
- Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis.World J Urol. 2020; (Published online June 14)https://doi.org/10.1007/s00345-020-03304-x
- Outcome of robotic radical prostatectomy in men over 74.J Endourol. 2018; 32: 106-110https://doi.org/10.1089/end.2017.0512
- Robotic-assisted radical prostatectomy in men ≥75 years of age. Surgical, oncological and functional outcomes.Anticancer Res. 2012; 32: 2085-2089
- Comparison of perioperative outcomes in elderly (age ≧ 75 years) vs. younger men undergoing robot-assisted radical prostatectomy.PLoS ONE. 2020; 15https://doi.org/10.1371/journal.pone.0234113
- Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy–A propensity score matched study.Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2015; 41: 837-843https://doi.org/10.1016/j.ejso.2015.04.006
- Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy.Int Braz J Urol Off J Braz Soc Urol. 2019; 45: 703-712https://doi.org/10.1590/S1677-5538.IBJU.2018.0704
- The effect of age on functional outcomes after radical prostatectomy.Urol Oncol Semin Orig Investig. 2015; 33 (203.e11-203.e18)https://doi.org/10.1016/j.urolonc.2015.01.015
- Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery.J Urol. 2010; 183: 1803-1807https://doi.org/10.1016/j.juro.2010.01.016
- Age and baseline quality of life at radical prostatectomy–who has the most to lose?.J Urol. 2014; 192: 396-401https://doi.org/10.1016/j.juro.2014.02.045
- Impact of age on quality-of-life outcomes after treatment for localized prostate cancer.Eur Urol. 2015; 68: 480-486https://doi.org/10.1016/j.eururo.2015.01.008
- The center for prostate disease research (CPDR): a multidisciplinary approach to translational research.Urol Oncol. 2009; 27: 562-569https://doi.org/10.1016/j.urolonc.2009.01.023
- Factors predicting early and late phase decline of sexual health-related quality of life following radical prostatectomy.J Sex Med. 2011; 8: 2935-2943https://doi.org/10.1111/j.1743-6109.2011.02387.x
- Double jeopardy? age, race, and HRQOL in older adults with cancer.J Cancer Epidemiol. 2012; 2012478642https://doi.org/10.1155/2012/478642
- Racial variation in patient-reported outcomes following treatment for localized prostate cancer: results from the CEASAR Study.Eur Urol. 2017; 72: 307-314https://doi.org/10.1016/j.eururo.2016.10.036
- Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer.Urology. 2000; 56: 899-905https://doi.org/10.1016/s0090-4295(00)00858-x
- SF-36 health survey update.Spine. 2000; 25: 3130-3139https://doi.org/10.1097/00007632-200012150-00008
- Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies.J Urol. 2004; 172: 2227-2231https://doi.org/10.1097/01.ju.0000145222.94455.73
- The effect of age on functional outcomes after radical prostatectomy.Urol Oncol Semin Orig Investig. 2015; 33: 333https://doi.org/10.1016/j.urolonc.2015.04.009
- Contemporary prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction.Cancer. 2014; 120: 1263-1271https://doi.org/10.1002/cncr.28563
- The comparative harms of open and robotic prostatectomy in population based samples.J Urol. 2016; 195: 321-329https://doi.org/10.1016/j.juro.2015.08.092
- Sexuality and health-related quality of life after prostate cancer in African-American and white men treated for localized disease.J Sex Marital Ther. 2004; 30: 79-93https://doi.org/10.1080/00926230490258884
- Health related quality of life differences between black and white men with prostate cancer: data from the cancer of the prostate strategic urologic research endeavor.J Urol. 2001; 166: 2281-2285https://doi.org/10.1016/S0022-5347(05)65551-6
Article info
Publication history
Published online: August 21, 2021
Accepted:
July 15,
2021
Received:
March 24,
2021
Footnotes
Disclosure: None.
USU-DoD-HJF Disclaimer: The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions or policies of Uniformed Services University of the Health Sciences (USUHS), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense (DoD) or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
