Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance

doi:10.1016/j.urology.2005.07.056

Urology

Volume 67, Issue 1, January 2006, Pages 125-130

https://doi.org/10.1016/j.urology.2005.07.056 Get rights and content

Abstract

Objectives

To assess the impact of lifestyle on health-related quality of life (HR-QOL), perceived stress, and self-reported sexual function in men with early-stage prostate cancer electing active surveillance.

Methods

A total of 44 intervention and 49 usual-care control participants were enrolled in a randomized clinical trial examining the effects of lifestyle changes on prostate cancer progression. The intervention consisted of a low-fat, vegan diet, exercise, and stress management. Participants completed the Medical Outcomes Study Short Form-36 Health Status Survey (a measure of mental and physical HR-QOL), the Perceived Stress Scale, the Sexual Function subscale of the University of California, Los Angeles, Prostate Cancer Index, and measures of lifestyle behaviors (to yield an overall lifestyle index) at baseline and 12 months. The data were analyzed using analysis of variance for repeated measures. The relationship between lifestyle and QOL was also analyzed using multiple linear regression analyses.

Results

Intervention participants had significantly improved their lifestyle compared with controls at 12 months. The quality-of-life scores were high across groups and time points. However, a healthier lifestyle was related to better QOL at baseline. Participants in both groups who reported a healthier lifestyle also reported better mental and physical HR-QOL and sexual function. Furthermore, participants whose lifestyle improved over time showed enhanced physical HR-QOL and decreased perceived stress.

Conclusions

Men who choose active surveillance for early-stage prostate cancer are able to make comprehensive lifestyle changes. Although the average QOL was already high in this sample, individuals who improved their lifestyle enhanced their QOL further.

Section snippets

Material and methods

A total of 93 men with biopsy-documented prostate cancer undergoing active surveillance, with prostate-specific antigen levels of 4 to 10 ng/mL and Gleason scores less than 7, were randomly assigned to a lifestyle intervention (n = 44) or usual-care control group (n = 49). These men then accepted an invitation to participate in the Prostate Cancer Lifestyle Trial. 18, 19 A randomized consent design was used to limit the amount of lifestyle information control participants received to reduce the

Participant Characteristics at Baseline

As shown in Table I, the experimental groups were similar in age, employment status, marital status, education, ethnicity, BMI, prostate-specific antigen level, and QOL at baseline. The control group scored somewhat higher on the lifestyle index compared with the intervention group.

Between-Group Differences in 12-Month Changes

Patients in the intervention group made significant improvements in lifestyle compared with the control group from baseline to 12 months. However, no significant differences between groups were found in the

Comment

The results of this study suggest that following a healthy lifestyle is positively related to QOL in men with early-stage prostate cancer choosing active surveillance. Specifically, a healthier lifestyle was associated with greater physical and mental HR-QOL and sexual function at study entry. Furthermore, intervention participants who made significant improvements in lifestyle during the 12-month period also reported improved physical HR-QOL and reduced perceived stress. Because some of the

Conclusions

The results of this study suggest that men with early-stage prostate cancer choosing active surveillance may improve their QOL by adopting healthy lifestyle practices. Future studies should examine further the effect of lifestyle changes in men choosing active surveillance, because this group of patients may increase proportionately with time owing to stage migration and receive less professional healthcare than those who seek conventional treatment. The current trial results suggest that men

Acknowledgment

To Representatives Nancy Pelosi and John Murtha and Senators Arlen Specter and Ted Stevens; and to Dennis Malone, Monika Sieverding, Monika Bullinger, and Michael Sumner for their contributions to the study.

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Cited by (109)

Diet and Health-related Quality of Life Among Men on Active Surveillance for Early-stage Prostate Cancer: The Men's Eating and Living Study (Cancer and Leukemia Group 70807 [Alliance])
2022, European Urology Focus
Citation Excerpt :
There were no significant differences in anxiety between Black/African American and other patients. Increased vegetable intake was not associated with differential changes in PRO scores in any of the domains compared with the control group, an observation consistent with a small RCT of an intervention combining vegan diet, exercise, and stress management [31]. A likely explanation is that lifestyle-focused interventions, such as diet, will not offer meaningful benefits for prostate cancer–associated HRQoL since these patients already experienced a high sense of well-being.
Health-related quality of life (HRQoL) among patients with localized prostate cancer (PC) on active surveillance (AS) and whether it may be improved through lifestyle-focused interventions remain underdefined.
To assess longitudinal changes in HRQoL in patients who received and those who did not receive a behavioral intervention that increased vegetable intake.
A secondary analysis of participants in the Men’s Eating and Living (MEAL) study (Cancer and Leukemia Group 70807 [Alliance]), a randomized trial of vegetable consumption in patients on AS, was conducted.
Patient-reported outcomes (PROs) included the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), the Expanded Prostate Cancer Index Composite 26 (EPIC-26), and the Functional Assessment of Cancer Therapy Scale—Prostate (FACT-P). Areas under the curves (AUCs) were used to summarize serial HRQoL.
PROs were completed in 87% (n = 387) of the intention-to-collect population. Baseline characteristics of patients completing HRQoL measures did not differ significantly from the entire study population or between groups. Baseline scores were high for all PROs and remained stable over 24 mo, with no significant differences from baseline at any time point. In adjusted analyses, there were no significant differences in summary AUC measures comparing control with intervention for the total MAX-PC score (p = 0.173); EPIC-26 domains of urinary incontinence (p = 0.210), urinary obstruction (p = 0.062), bowel health (p = 0.607), sexual health (p = 0.398), and vitality (p = 0.363); and total FACT-P scores (p = 0.471).
Among men with localized PC on AS enrolled in a randomized trial, HRQoL was high across multiple domains at baseline, remained high during follow-up, and did not change in response to a behavioral intervention that increased vegetable intake.
Patients with localized prostate cancer enrolled on active surveillance experience minimal cancer-associated anxiety, suffer low levels of cancer-associated symptoms, and perceive high physical and emotional well-being.
Effects of Exercise on Sexual Dysfunction in Patients With Prostate Cancer – A Systematic Review
2021, Journal of Sexual Medicine
Citation Excerpt :
8 studies (34%) used the specific sexual function questionnaires IIEF-1527,34 and IIEF-5,28,41–44,46 while twelve (52%) studies used questionnaires that included a sexual function subscale.26,27,29,31,33,35–40,45 These are the EORTC QLQ-PR25,26,27,29,31,33,35 the EPIC,27 the EPIC-26,37,40 the UCLA-PCI36,38,45 and the IIS.39 All questionnaires are validated questionnaires.48–54
Emerging evidence suggests that exercise interventions may improve sexual dysfunction, one of the most common and distressing long-term adverse effects of cancer treatment.
The aim of this systematic review is to provide an overview of the effects of exercise on sexual dysfunction in prostate cancer patients.
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The systematic literature search was performed on 13th July 2021 using CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing sexual function in prostate cancer patients conducting an exercise intervention alone or in combination with other supportive interventions. The methodological quality was assessed using the Physiotherapy Education Database Score and Jadad scale. Outcomes were reported as between-group differences. Intragroup differences were also reported if significant.
Positive intervention effects on sexual function were primarily observed in patients following prostatectomy and undergoing anti-hormone treatment and for pelvic floor muscle exercises as well as aerobic and resistance exercise.
22 RCTs (n = 1.752 patients) met the eligibility criteria, conducting either an exercise-only intervention (n = 10), a multimodal (exercise plus other supportive therapy) intervention (n = 4), or pelvic floor muscle exercises (n = 8). 6 RCTs assessed sexual dysfunction as a primary endpoint and 8 RCTs used dedicated assessment methods. 9 of the 22 RCTs found significant between-group differences in favor of the intervention group.
The multifaceted etiology of sexual dysfunction provides a strong rationale to further investigate the effects of exercise on sexual dysfunction in prostate cancer patients and also to consider a multidisciplinary approach.
A strength is the comprehensive literature search to identify RCTs involving different exercise interventions and a wide range of sexual function assessments. Further, this is the first systematic review on this topic. The main limitations include the difficulty to compare studies due to the heterogeneity of exercise interventions and low questionnaire completion rates in some studies.
Preliminary data from a small number of studies suggest that certain exercise interventions may improve sexual dysfunction in prostate cancer patients, however further trials involving sexual dyfunction as a primary outcome and more comprehensive assessment tools are needed to confirm the rehabilitative and preventive effects of exercise on sexual dysfunction in prostate cancer patients.
Nadine Reimer, Eva Maria Zopf, Rebecca Böwe, et al. Effects of Exercise on Sexual Dysfunction in Patients With Prostate Cancer – A Systematic Review. J Sex Med 2021;18:1899–1914.
Unmarried men have worse oncologic outcomes after radical cystectomy for nonmetastatic urothelial bladder cancer
2020, Urologic Oncology: Seminars and Original Investigations
Unmarried status is an established risk factor for worse cancer control outcomes and survival in various malignancies. We tested the effect of marital status on the rate of nonorgan confined disease as well as on cancer-specific mortality (CSM) in patients who underwent radical cystectomy for nonmetastatic urothelial bladder cancer (UCUB).
Within the Surveillance, Epidemiology and End Results database (2007-2015), we identified 11,167 patients (8,639 men and 2,528 women) who underwent radical cystectomy for nonmetastatic UCUB. Temporal trend analyses, logistic regression models, cumulative incidence plots, competing-risks regression models and landmark analyses were used.
Overall, 2,454 men (28.4%) and 1,363 women (53.9%) were unmarried. Unmarried men had a higher rate of nonorgan-confined disease at radical cystectomy (OR: 1.24, CI 1.10–1.33; P < 0.001). Moreover, in men, unmarried status was an independent predictor of higher CSM (HR: 1.24, CI 1.12–1.37) In women, unmarried status neither predicted nonorgan-confined disease at radical cystectomy (OR: 1.07, CI 0.91–1.26; P = 0.37) nor was it associated with CSM (HR: 1.13, CI 0.88–1.31; P = 0.14). In 6-month landmark analyses, unmarried status remained an independent predictor of higher CSM in men (HR: 1.20, CI 1.08–1.33).
Unmarried men have more advanced tumor stage at radical cystectomy and worse CSM compared to married men. Interestingly, marital status did not affect oncologic outcomes in women. These data suggest a gender-specific effect of marital status in UCUB.
Contemporary analysis of the effect of marital status on survival of prostate cancer patients across all stages: A population-based study
2019, Urologic Oncology: Seminars and Original Investigations
Marital status rates may have changed over time in prostate cancer (PC) patients and may have affected cancer-specific mortality (CSM) and other-cause mortality (OCM).
Within the Surveillance, Epidemiology, and End Results database (2004–2015), we identified PC patients who were either married (n = 326,664) or unmarried (n = 106,533). Temporal trends, cumulative incidence plots, as well as multivariable competing risks regression analyses focused on (1) the overall population, (2) D'Amico low-risk N0M0 PC, (3) D'Amico intermediate-risk N0M0 PC, (4) D'Amico high-risk N0M0 PC, (5) N1M0 PC, and (6) M1 PC patients.
Of all, 24.6 % were unmarried and increased trend over time (23.0%–26.9%, P < 0.001). Unmarried men experienced higher CSM rates (9.8% vs. 6.3% in married men, P < 0.001) and OCM rates (24.3% vs. 17.1% in married men, P < 0.001) in the overall population, as well as in all subgroup analyses. Unmarried status represented an independent predictor of higher CSM (hazard ratio: 1.19, P < 0.001) and OCM (hazard ratio: 1.41, P < 0.001) in the overall cohort, as well as in all subgroup analyses except for the N1M0 subgroup, where marital status did not reach independent predictor status for CSM.
Unmarried PC patients are at higher risk of CSM and OCM. This relationship applies to all stage subgroups, except for the N1M0 subgroup. Consequently, unmarried individuals should ideally benefit of improved counseling, closer follow-up, as well as of other measures aimed at reducing the CSM and OCM disadvantages.
Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis
2018, Cancer Treatment Reviews
The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments.
We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747.
Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I² = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (−0.46SD 95%CI −0.55, −0.36), small urinary incontinence (−0.16SD 95%CI −0.23, −0.09) and bowel impairment (−0.31SD 95%CI −0.39, −0.23). Brachytherapy patients presented small deterioration in urinary incontinence (−0.29SD 95%CI −0.39, −0.19), irritative obstructive symptoms (−0.35SD 95%CI −0.47, −0.23), sexual function (−0.12SD 95%CI −0.24, −0.002), and bowel bother (−0.27SD 95%CI −0.42, −0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening.
No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
Low risk prostate cancer and an opportunity lost: More activity required in active surveillance
2018, Medical Journal of Australia

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: Major support for this study was provided by grants from the Department of Defense Uniformed Services University (USU grant MDA905-99-1-0003) by way of the Henry M. Jackson Foundation (grant 600-06971000-236), the Prostate Cancer Foundation, and National Institutes of Health grant 5P50CA089520-02 UCSF Prostate Cancer Specialized Program of Research Excellence (SPORE). Additional support was provided by the Department of Defense (grant W81XWH-05-1-0375-P0001) and the following foundations: Ellison, Fisher, Gallin, Highmark Blue Cross Blue Shield, Koch, Resnick, Wachner, Walton Family, and Wynn.

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Adult urologyLifestyle and health-related quality of life of men with prostate cancer managed with active surveillance

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and methods

Participant Characteristics at Baseline

Between-Group Differences in 12-Month Changes

Comment

Conclusions

Acknowledgment

Int J Radiat Oncol Biol Phys

Urology

Lancet

J Urol

J Urol

Urology

Urology

J Urol

Urology

J Urol

J Am Diet Assoc

J Urol

Urinary and sexual function after radical prostatectomy for clinically localized prostate cancerthe Prostate Cancer Outcomes Study

JAMA

Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy

J Natl Cancer Inst

Adult urology
Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance