Aims: Survival rates for prostate cancer (PC) are rising yet there is limited research into psychological and quality of life (QoL) changes from curative treatment into survivorship. The objectives were to examine patterns and predictors of these outcomes in men receiving curative radiotherapy for PC.
Methods: 159 men receiving radiotherapy completed reliable and valid measures at treatment commencement (T1), completion (T2) and six-months post-treatment (T3). Measures assessed psychological morbidity (Hospital Anxiety Depression Scale: HADS) and prostate-specific QoL (EPIC: Expanded Prostate Index Composite).
Results: Depression increased significantly to T2 (HADS-D: mean difference [MD] =0.55 (95% CI:0.23,0.86), p=0.001), a result sustained to T3. In contrast, anxiety declined substantially by T2 (HADS-A: MD=-0.83 (95% CI:-1.29,-0.37), p<0.001), followed by a modest increase. Urinary, bowel and sexual function worsened significantly from T1 to T2 (urinary MD=-11.06 (95% CI:-13.49,-8.64); bowel MD=-15.82 (95% CI:-18.49,-13.14); sexual MD=-5.14 (95% CI:-7.87,-2.41), p<0.001). Urinary function returned to baseline levels at T3 however improvement in bowel and sexual function remained significantly lower than baseline (bowel MD=-6.41 (95% CI:-9.00,-3.82), p<0.001; sexual MD=-3.91 (95% CI:-7.25,-0.56), p=0.02). Mixed models analysis revealed predictors of depression included rural residence (MD=1.48 (95% CI:-0.07,1.84), p=0.007) and no university education, (MD=-1.12 (95% CI:-2.16,-0.08), p=0.03). Patients whose first language was not English reported higher depression (MD=1.77 (95% CI:0.69,2.84), p=0.001) and anxiety (MD=1.73 (95% CI:0.53,2.94), p=0.005). Decreased sexual function was strongly predicted by older age (MD=-4.79 (95% CI:-7.49,-2.08), p=0.001) and previous treatment (prostatectomy MD=-23.08 (95% CI:-32.08,-14.09), p<0.001; hormone therapy MD=-24.14 (95% CI:-32.70,-15.57), p<0.001).
Conclusions: Men who receive radiotherapy for PC undergo significant psychological and QoL changes over time. Interventions are required that target men not only during treatment, but also at treatment completion and into survivorship. Patients from rural areas, whose first language is not English, or who receive combined modality treatments would likely benefit most from screening and targeted management.