Abstract

Background: Prostate cancer is a serious problem throughout the Western hemisphere. Because a number of effective treatment options for localized cancer are now available, it is important to consider quality of life when selecting a treatment. This study evaluated quality of life in patients with localized prostate cancer before and after treatment with radical prostatectomy. Methods: This was a prospective open cohort study. Fifty-five patients treated for localized prostate cancer on the Urology Service of two health care facilities were screened for inclusion. Quality of life parameters were evaluated using the UCLA Prostate Cancer Index questionnaire prior to treatment and 3, 6, 9, 12, and 18 months after surgery. Scores were compared using the Mann Whitney U test, with the level of statistical significance set at p<0.05. Multivariate analysis was used to identify factors predictive of recovery to at least 70% of baseline function. Results: Fifty-five patients were enrolled and followed for at least 12 months. Mean age was 65.3 years (range 44-78, SD 7.8). At the 3-month evaluation, there was a significant decline in urinary (80 vs. 59; p<0.001) and sexual (53 vs. 24; p<0.001) function as compared with baseline. Bowel function did not suffer a significant decline during the evaluation period. Both urinary (59 vs. 69.1; p=0.03) and sexual (24 vs. 33.8; p=0.02) function recovered significantly by 18 months as compared with 3 months. Multivariate analysis indicated that age, prostate-specific antigen level, lack of postoperative radiation, and preservation of the neurovascular bundles were protective factors against loss of more than 30% of baseline sexual and urinary function. Conclusions: Urinary and sexual function both suffered a significant decline in patients who underwent radical prostatectomy; however, these functions tended to recover over time. Age, prostate-specific antigen level, and preservation of the neurovascular bundles were protective factors associated with early recovery of many functions.