Clinical Implications of Measuring Quality-of-Life in Early Stage Prostate Cancer

Prostate cancer is a unique malignancy: it is the most prevalent cancer in men (CA Cancer J Clin 60(5):277–300, 2010), and yet most cases have a relatively indolent course when compared to other malignancies, with most men dying from other causes before becoming symptomatic (Am J Epidemiol 148:775–785, 1998). Because an informed medical decision can only be made with a thorough understanding of the risks and benefits of each management option, an increasingly bright spotlight has been placed on the effects of prostate cancer treatment on patients’ health-related quality-of-life (HRQOL), as every treatment modality for early stage prostate cancer portends distinct HRQOL consequences (JAMA 273:129–135, 1995; J Natl Cancer Inst 92:1582–1592, 2000; N Engl J Med 358:1250–1261, 2008). Prostatectomy carries an increased risk of urinary incontinence, external radiotherapy and brachytherapy can cause bowel toxicity and urinary obstruction or irritation, hormonal therapy affects vitality, and each of these treatments can result in deterioration of sexual function. While the presence of these adverse outcomes can sometimes be self-evident during the course of routine clinical care, objectively quantifying such outcomes can be challenging.