Impact of different treatment modalities for localized prostate cancer on patient-reported quality of life outcomes in an Asian Cohort

Abstract

Abstract This study aimed to provide a long-term comparison of patient-reported functional outcomes (PROs) across various treatments for localized PCa over five years in an Asian population. This was a prospective study involving 866 patients with PCa who were undergoing treatment, including active surveillance (AS)( n  = 126), radical prostatectomy (RP) ( n  = 332), radiation therapy (RT) ( n  = 339) and focal therapy (FT)( n  = 69). Patients were required to complete the EPIC-26 questionnaire at baseline and annually for 5 years, and were followed up until the most recent completion of the questionnaire, loss to follow-up, or death. Longitudinal functional outcomes were analyzed using linear mixed-effects models; the model included fixed effects for treatment modality, time, a treatment×time interaction, and clinically relevant covariates, including age, body mass index (BMI), Charlson Comorbidity Index, and AUA risk group classification. Over a median follow-up of 42.81months, RP resulted in the worst outcome in urinary continence (mean difference: −19, 95%CI: −24 to − 14; P  < 0.001) and sexual function mean difference: −22, 95%CI: −26 to − 17; P  < 0.001) in the first year, as compared to AS. RT was associated with an early decline in bowel function and hormonal dysfunction, which was most severe at 1–3 years, but both functions had recovered afterwards. FT was associated with favorable functional preservation in most domains compared to RP and RT, though sexual function declined progressively from baseline. No significant differences in sexual function were observed between FT and AS beyond 1 year. Different treatment modalities (AS, RP, RT, FT) resulted in distinct functional outcomes profiles.