Health-related quality of life (HRQOL) is a legitimate construct for evaluating treatment and its side effects. Recently, predictive value of HRQOL on survival also has been of interest. In light of the longer survival in patients with prostate cancer and importance of quality of life, we seek to evaluate the association between HRQOL and survival using traditional and novel techniques. Patients from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) who were treated within 6 months of diagnosis and had pre-treatment and sufficient post-treatment follow-up information constituted the study population. A sample consisting of 2,899 patients met the study criteria. SF-36 domains were used to measure HRQOL outcomes. Categorical variables were created for HRQOL based on the baseline distribution of the lower 10th percentile and the remainder of the patients. Association between HRQOL and survival (defined by all-cause mortality) in patients with prostate cancer was evaluated using Cox proportional hazards models controlling for age at diagnosis, type of treatment received, clinical risk classification, and number of comorbidities. Sequential bootstrap resampling was implemented to evaluate stability of the model. Univariate and multivariate Cox proportional hazards models were fit using various time points over the course of follow-up. In the analysis looking at association of HRQOL baseline measurements, higher levels of physical function and general health were significantly associated with better survival (HR 0.49 95% CI 0.32–0.78 and HR 0.51 95% CI 0.35–0.75, respectively). Post-treatment analysis demonstrated similar results. In time-dependent analysis, higher levels of physical function, role physical, and general health were significantly associated with better survival (HR ranged from 0.57 to 0.65). In addition, analysis looking at change in HRQOL scores demonstrated an association between higher scores on physical function, role physical, vitality, social function, and general health and longer survival (HR ranged from 0.56 to 0.63). This study demonstrated that several domains of HRQOL were significantly associated with survival in a large group of patients with localized prostate cancer. This association was maintained over the course of disease regardless of the time of the assessment. Results from our study have both research and clinical relevance. They could provide information that enable us to not only improve communication with patients and families, but also to develop interventions and treatments best suited for the patient.

Introduction

Health-related quality of life (HRQOL) is a legitimate construct for evaluating treatment and its side effects. Recently, predictive value of HRQOL on survival also has been of interest. In light of the longer survival in patients with prostate cancer and importance of quality of life, we seek to evaluate the association between HRQOL and survival using traditional and novel techniques.

Methods

Patients from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) who were treated within 6 months of diagnosis and had pre-treatment and sufficient post-treatment follow-up information constituted the study population. A sample consisting of 2,899 patients met the study criteria. SF-36 domains were used to measure HRQOL outcomes. Categorical variables were created for HRQOL based on the baseline distribution of the lower 10th percentile and the remainder of the patients. Association between HRQOL and survival (defined by all-cause mortality) in patients with prostate cancer was evaluated using Cox proportional hazards models controlling for age at diagnosis, type of treatment received, clinical risk classification, and number of comorbidities. Sequential bootstrap resampling was implemented to evaluate stability of the model. Univariate and multivariate Cox proportional hazards models were fit using various time points over the course of follow-up.

Results

In the analysis looking at association of HRQOL baseline measurements, higher levels of physical function and general health were significantly associated with better survival (HR 0.49 95% CI 0.32-0.78 and HR 0.51 95% CI 0.35-0.75, respectively). Post-treatment analysis demonstrated similar results. In time-dependent analysis, higher levels of physical function, role physical, and general health were significantly associated with better survival (HR ranged from 0.57 to 0.65). In addition, analysis looking at change in HRQOL scores demonstrated an association between higher scores on physical function, role physical, vitality, social function, and general health and longer survival (HR ranged from 0.56 to 0.63).

Conclusion

This study demonstrated that several domains of HRQOL were significantly associated with survival in a large group of patients with localized prostate cancer. This association was maintained over the course of disease regardless of the time of the assessment. Results from our study have both research and clinical relevance. They could provide information that enable us to not only improve communication with patients and families, but also to develop interventions and treatments best suited for the patient.

Unlabelled

Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Although phosphodiesterase inhibitor use post radical prostatectomy improves potency, little is known about its affects on sexual bother. We found no difference in sexual bother scores between patients who use and do not use phosphodiesterase inhibitors. This suggests that the current definition of potency, inclusive of medication use, is valid with respect to sexual bother.

Objective

To determine whether the current definition of potency, inclusive of phosphodiesterase inhibitor (PDEi) use, is valid with respect to sexual bother (SB). This will be assessed by characterizing the effect of PDEi use on SB scores in men who are potent post radical prostatectomy.

Patients and methods

The study population consisted of patients who were potent both before and after radical prostatectomy, with at least 2 years of follow-up. Disease-specific quality of life data were evaluated by the University of California, Los Angeles, Prostate Cancer Index (PCI) survey. The relationships between changes in sexual function (SF) and SB and use of PDEi over time were evaluated by mixed model analysis controlling for age, clinical risk group, marital status, and time of PCI assessment.

Results

Of the 246 patients who met the study criteria, 39% reported PDEi use at some point after treatment. PDEi use was not associated with improved SF (P= 0.81). Furthermore, PDEi use was not associated with a change in SB (P= 0.36). Both SF and SB were significantly associated with time of assessment and age, and SF and SB each improved over time. In addition, SB was significantly associated with marital status.

Conclusions

In this analysis, there was no difference in SF scores between men who were potent with or without the use of PDEi. Furthermore, there was no difference in SB scores between men who were potent with or without the use of PDEi. This suggests that the current, inclusive, definition of potency is valid with respect to SB.

Purpose

There is much debate about whether 1 or 2, 24-hour urinalyses are adequate for metabolic evaluation of stone formers. We determined whether repeat 24-hour urine collection provides information similar to that of the initial 24-hour urine collection and whether repeat collection is necessary.

Materials and methods

We analyzed 2, 24-hour urine collections in 777 patients obtained from 2001 to 2005. Samples were collected 3 days or less apart before pharmacological intervention and analyzed elsewhere for routine stone risk profiles of urine calcium, oxalate, citrate, uric acid, sodium, potassium, magnesium, phosphorus, ammonium, chloride, urea nitrogen and creatinine.

Results

No parameters showed a statistically significant difference between 24-hour urine samples 1 and 2 when mean values were compared (pairwise t test each p >0.05, range 0.06 to 0.87). Using Pearson's correlation all parameters showed positive correlation coefficients (r = 0.68 to 0.89, each p <0.0001). The mean of individual patient differences in samples 1 and 2 were compared to 0 and 6 of 12 showed no difference (p >0.05) while for the remaining 6 p value was <0.05. The percent difference was 0.5% to 4.19% for all urinary parameters.

Conclusions

One 24-hour urine sample is sufficient for metabolic evaluation of recurrent stone disease. There is no significant difference in 12 urinary parameters between 24-hour urine samples collected within 3 days of each other. This information is useful to providers and may decrease patient inconvenience and the overall cost of metabolic stone evaluation.

Purpose

Patients with prostate cancer and high risk disease characteristics may benefit from multimodal therapy. However, the effects of multimodal therapy on health related quality of life have not been comprehensively described. We further characterized health related quality of life in patients treated with multimodal therapy.

Materials and methods

Patient data were obtained from the CaPSURE database, a national disease registry of men with prostate cancer. Included patients received active primary therapy (ie surgery or various forms of radiation) for prostate cancer with or without adjuvant or neoadjuvant therapy, and had complete clinical data, including health related quality of life assessments at baseline and through 2 years after treatment. The association between health related quality of life outcomes and different primary therapies with and without adjuvant or neoadjuvant therapy over time was analyzed using a repeated measures mixed model for each primary therapy.

Results

A total of 2,204 men met the study criteria. As primary therapy 1,427 patients received radical prostatectomy, 267 received external beam radiation therapy and 510 received brachytherapy. When androgen deprivation therapy was included with radical prostatectomy, brachytherapy or external beam radiation therapy, there was a transient loss of sexual function that improved within 9 months postoperatively. When external beam radiation therapy was given with brachytherapy there was continuous worsening of urinary function and bother through 21 months.

Conclusions

Multimodal therapy may lead to declines in health related quality of life especially in the domains of urinary function, urinary bother and sexual function. These effects must be considered and patients must be counseled appropriately before initiation of multimodal therapy.

Background

Recent data have suggested that clinical T stage is not independently associated with biochemical recurrence of localized prostate cancer after radical prostatectomy. One explanation for this lack of predictive power may be the inaccurate application of staging criteria.

Methods

Data from men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with localized prostate cancer (clinical T1-T2) were analyzed. Correct stage was determined by digital rectal examination (DRE) and transrectal ultrasound (TRUS) findings and was compared with the clinical stage reported directly by the practitioner. DRE/TRUS findings and biopsy results were evaluated to determine factors influencing staging errors. The ability of corrected stage to predict biochemical disease recurrence after prostatectomy was assessed using multivariable analysis.

Results

Clinical stage was assigned incorrectly in 1370 of 3875 men (35.4%). Errors more commonly resulted in patient downstaging than upstaging (55.1% vs 44.9%; P < .001). Patients with TRUS lesions were more likely to be staged incorrectly than those with abnormal DRE findings (65.8% vs 38.2%; P < .001). Biopsy laterality was found to strongly influence stage assignment. Even after correction of staging errors, there was no association noted between clinical stage and biochemical disease recurrence after radical prostatectomy.

Conclusions

Errors in applying clinical staging criteria for localized prostate cancer are common. TRUS findings are frequently disregarded, and practitioners incorrectly incorporate biopsy results when assigning stage. However, staging errors do not appear to account for the inconsistent reliability of clinical stage in predicting prostate cancer outcomes. These findings further challenge the utility of a DRE-based and/or TRUS-based staging system for risk assessment of localized prostate cancer.

Background

As androgen deprivation therapy (ADT) becomes a standard of treatment for men with recurrent or metastatic prostate cancer, evaluation of adverse effects associated with this treatment is needed. In this study, the authors evaluated the effect of ADT administered as monotherapy and in combination with local treatment on physical well-being in a longitudinal sample of men with prostate cancer.

Methods

Exposure to ADT was defined by 3 groups: local (local treatment only), combination (local treatment with adjuvant and/or neoadjuvant ADT), and primary ADT. Associations between exposure to ADT and physical well-being measured by self-reported health-related quality of life outcomes over time were evaluated by repeated measures analysis using mixed modeling. Estimates adjusted for various clinical and demographic variables are reported.

Results

A total of 2922 men, who completed both pretreatment and follow-up health-related quality of life assessment, were identified from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. During 24 months of follow-up, exposure to ADT was associated with worse physical well-being compared with local treatment at all time points (P < .001). Being exposed to ADT as primary therapy was associated with more severe declines compared with combination therapy.

Conclusions

The potential consequence of decline in physical well-being in patients exposed to ADT has to be included in treatment decision making.

Objective

To evaluate the influence of comorbid cardiovascular disease severity on health-related quality of life (HRQL) in men treated with radical prostatectomy (RP) or radiotherapy (RT) for early stage prostate cancer.

Methods

Subjects (n=830) with non-metastatic disease who had been diagnosed in 2000-2002 were drawn from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). We evaluated the influence of cardiovascular disease (CVD) severity on generic and disease-specific HRQL before and 6, 12, 18, and 24 months after treatment with RP or RT. HRQL was measured with the SF-36 and the UCLA Prostate Cancer Index.

Results

Men with moderate (n=193) or severe (n=51) cardiovascular disease had worse pre-treatment HRQL than did men without CVD (n=293) (P<0.01); HRQL scores were worse in men referred for RT. During 24 months of follow-up, men with moderate or severe CVD had worse SF-36 physical and mental component summaries and worse bowel function at all time points (P<0.05). Men with severe CVD also experienced a slower recovery in physical function (P=0.03) and sexual functioning (P=0.02) than did men without CVD.

Conclusions

Prostate cancer patients with moderate to severe CVD have worse HRQL during follow-up. Those with severe CVD recover their physical and sexual functioning more slowly after treatment.

Purpose

Intestinal calcium absorption is thought to have a critical role in nephrolithiasis. However, to our knowledge no study has directly assessed this association. Therefore, we explored the relationship among intestinal fractional calcium absorption, calcium intake and nephrolithiasis.

Materials and methods

The Study of Osteoporotic Fractures is a prospective cohort of 9,704 postmenopausal women recruited from population based listings in 1986 and followed for more than 20 years. Secondary analyses were performed of 7,982 women who reported their history of nephrolithiasis, of which 5,452 (68%) underwent an oral radioactive calcium assay (45Ca). The impact of dietary and supplemental calcium on intestinal fractional calcium absorption was evaluated, and factors independently associated with nephrolithiasis were determined.

Results

Fractional calcium absorption decreased with increased calcium intake, with no difference between dietary and supplemental calcium. Fractional calcium absorption was higher in women with a nephrolithiasis history among all calcium intake groups. Increased dietary calcium intake reduced the likelihood of nephrolithiasis by 45% to 54% (p=0.03). Women with a history of nephrolithiasis were less likely to supplement calcium (p<0.001). In adjusted analyses women who supplemented calcium were 21% to 38% less likely to have a nephrolithiasis history (p=0.007) and there was a 24% increased risk of kidney stones for each 10% increase in fractional calcium absorption (p=0.008).

Conclusions

Fractional calcium absorption is higher in women with a history of nephrolithiasis. Higher intestinal fractional calcium absorption is associated with a greater risk of historical nephrolithiasis. Dietary and supplemental calcium decrease fractional calcium absorption, and may protect against nephrolithiasis.

Background

Few studies of ethnicity and prostate cancer have included Latino men in analyses of baseline clinical characteristics, treatment selection, and disease-free survival (DFS). The present study examines the impact of Latino ethnicity on these parameters in a large, multiinstitutional database of men with prostate cancer.

Methods

We compared baseline disease characteristics and clinical outcomes for Latino (N = 138), non-Latino White (NLW, N = 5619), and African-American (AA, N = 608) men with localized prostate cancer by using chi-square and ANOVA for baseline variables and survival analysis to examine differences in time to recurrence.

Results

Latino men resembled AA men more than NLW on sociodemographic characteristics. AA men had higher Gleason scores and prostate-specific antigen (PSA) at diagnosis than Latino or NLW men (both P < 0.01). 10% of both Latino and AA men presented with advanced disease (T3b/T4/N+/M+) versus 4% of NLW (P < 0.01). Latino men did not receive different treatments than NLW or AA men after controlling for clinical and demographic factors; however, AA men were more likely to receive external beam radiation (OR = 1.51, 95% confidence interval [CI] = 0.99-2.31) and hormone treatment (OR = 1.56, 95% CI = 1.05-2.32) then NLW men. For prostatectomy patients, 3-year actuarial DFS rates were 83% for NLW men and 86% for Latino men versus 69% for AA men (P < 0.01). After controlling for clinical and sociodemographic variables, AA men were somewhat more likely than NLW to experience disease recurrence after radical prostatectomy (RP) (HR = 1.38, 95% CI = 0.98-1.94, P = 0.06).

Conclusions

Latinos are more similar to African Americans on sociodemographic characteristics but more similar to NLW on clinical presentation, treatments received, and DFS.