UroToday - R. Jayadevappa and colleagues of the University of Pennsylvania present their observations on health related quality of life (HRQol) and Client Satisfaction with Care (CSQ-8) and other factors in 115 older men (?65 yrs) who had RP (69) or EBRT (46) at either the Veterans Hospital or the University Hospital. They surveyed the men at 3, 6 and 12 months.

They especially noted whether or not the patients returned to baseline or not, and if they did so, the duration until that return. Certain comorbid and demographic factors were reviewed, also. Their method was a structured chart review.

Their significant observations include: patients choosing RP were more likely to be Caucasian, college-educated, working full time (i.e. not retired), married and with an annual income over $40,000. They were also younger (67.4 yrs) than the EBRT group (71.5 yrs). The two groups did not differ significantly in Charlson Scores, PSA at diagnosis, PSA after treatment and TNM stage.

However, more EBRT patients had Gleason scores of 2-6 or 8-10. They make several generalizations from their data. For cancer related HRQol, at 12 months, more of the RP group had returned to baseline bowel and urinary function and had less bowel bother. EBRT patients showed better urinary and sexual function.

They report multiple other relationships that must be gleaned from the article itself. Their overall summary of the study emphasizes that at 12 months, the RP group had "significantly better generic HRQol than the EBRT group".

The RP group also showed at 12 months significant improvements in bowel function and bother, and less urinary bother, but they showed lower overall urinary and sexual function, and more sexual bother. (One can imply that the problems of urinary function were related to incontinence, perhaps, and that sexual function may well return after 12 months.) Older age, higher Gleason score and greater TNM stage were associated with selection of EBRT as treatment. And, finally, they noted no difference in satisfaction of care between the groups.

Comment: Of importance, this study applied itself to men at or over age 65, and indeed most did very well with either RP or EBRT. Since the average male at age 65 can now expect to live more than 17 years, it seems that we must consider the factors noted by these authors in offering treatment to these older patients. The authors agree, however, that their study was limited by only 12 months of observation and used only two local hospitals for sampling. Larger and longer studies are needed.

Reviewed by George W. Drach MD

BJU International 2006;97(5):955-962
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