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Impact of Age and Race on Health-Related Quality of Life Outcomes in Patients Undergoing Radical Prostatectomy for Localized Prostate Cancer

  • Natasza Posielski
    Affiliations
    Virginia Mason Franciscan Health, Seattle, WA
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  • Jason Frankel
    Affiliations
    Virginia Mason Franciscan Health, Seattle, WA

    Washington St. Louis University, St. Louis, MO
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  • Huai-Ching Kuo
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD

    Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
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  • On Ho
    Affiliations
    Virginia Mason Franciscan Health, Seattle, WA
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  • Sally Elsamanoudi
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Darryl Nousome
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD

    Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD
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  • Ryan Speir
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    Madigan Army Medical Center, Tacoma, WA
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  • Sean Stroup
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    Naval Medical Center, San Diego, CA
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  • John Musser
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    Tripler Army Medical Center, Honolulu, HI
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  • Alexander Ernest
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    Brooke Army Medical Center, Fort Sam Houston, TX
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  • Gregory T. Chesnut
    Affiliations
    Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

    Walter Reed National Military Medical Center, Bethesda, MD
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  • Timothy Tausch
    Affiliations
    Walter Reed National Military Medical Center, Bethesda, MD
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  • John Paul Flores
    Affiliations
    Virginia Mason Franciscan Health, Seattle, WA
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  • Christopher Porter
    Correspondence
    Address correspondence to: Christopher Porter, MD, Medical Director, Clinical Research at Virginia Mason, Director, Urologic Oncology Fellowship, Co-Director, Urologic Oncology, Virginia Mason Medical Center, 1100 Ninth Ave., C7-URO, Seattle, WA, 98101.
    Affiliations
    Virginia Mason Franciscan Health, Seattle, WA
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      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.
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      References

      1. Cancer of the prostate - cancer stat facts. SEER. Accessed July 15, 2019. https://seer.cancer.gov/statfacts/html/prost.html

      2. NCCN - evidence-based cancer guidelines, oncology drug compendium, oncology continuing medical education. Accessed December 9, 2020. https://www.nccn.org/

        • Bechis SK
        • Carroll PR
        • Cooperberg MR.
        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
        • Greco KA
        • Meeks JJ
        • Wu S
        • Nadler RB.
        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
        • Gurung PMS
        • Wang B
        • Hassig S
        • et al.
        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
        • Ubrig B
        • Boy A
        • Heiland M
        • Roosen A.
        Outcome of robotic radical prostatectomy in men over 74.
        J Endourol. 2018; 32: 106-110https://doi.org/10.1089/end.2017.0512
        • Labanaris AP
        • Witt JH
        • Zugor V.
        Robotic-assisted radical prostatectomy in men ≥75 years of age. Surgical, oncological and functional outcomes.
        Anticancer Res. 2012; 32: 2085-2089
        • Yamada Y
        • Teshima T
        • Fujimura T
        • et al.
        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
        • Kumar A
        • Samavedi S
        • Bates AS
        • et al.
        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
        • Neumaier MF
        • Segall CH
        • Hisano M
        • Rocha FET
        • Arap S
        • Arap MA.
        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
        • Mandel P
        • Graefen M
        • Michl U
        • Huland H
        • Tilki D.
        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
        • Shikanov S
        • Desai V
        • Razmaria A
        • Zagaja GP
        • Shalhav AL.
        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
        • Brajtbord JS
        • Punnen S
        • Cowan JE
        • Welty CJ
        • Carroll PR.
        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
        • Hampson LA
        • Cowan JE
        • Zhao S
        • Carroll PR
        • Cooperberg MR.
        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
        • Brassell SA
        • Dobi A
        • Petrovics G
        • Srivastava S
        • McLeod D.
        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
        • Kimura M
        • Bañez LL
        • Schroeck FR
        • et al.
        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
        • Bellizzi KM
        • Aziz NM
        • Rowland JH
        • et al.
        Double jeopardy? age, race, and HRQOL in older adults with cancer.
        J Cancer Epidemiol. 2012; 2012478642https://doi.org/10.1155/2012/478642
        • Tyson MD
        • Alvarez J
        • Koyama T
        • et al.
        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
        • Wei JT
        • Dunn RL
        • Litwin MS
        • Sandler HM
        • Sanda MG.
        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
        • Ware JE.
        SF-36 health survey update.
        Spine. 2000; 25: 3130-3139https://doi.org/10.1097/00007632-200012150-00008
        • Kundu SD
        • Roehl KA
        • Eggener SE
        • Antenor JAV
        • Han M
        • Catalona WJ.
        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
        • Bolat D
        • Gunlusoy B.
        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
        • Resnick MJ
        • Barocas DA
        • Morgans AK
        • et al.
        Contemporary prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction.
        Cancer. 2014; 120: 1263-1271https://doi.org/10.1002/cncr.28563
        • O'Neil B
        • Koyama T
        • Alvarez J
        • et al.
        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
        • Jenkins R
        • Schover LR
        • Fouladi RT
        • et al.
        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
        • Lubeck Deborah P.
        • Howard Kim
        • Gary Grossfeld
        • et al.
        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