The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study

Authors

  • Reidun Sletten The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Department of Oncology and Palliative Care, Innlandet Hospital Trust, Gjøvik/Lillehammer, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway https://orcid.org/0009-0007-1192-2376
  • Ola Berger Christiansen The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Department of Urology, Innlandet Hospital Trust, Hamar, Norway
  • Line Merethe Oldervoll Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre for Crisis Psychology, Faculty of Psychology University of Bergen, Bergen, Norway
  • Lennart Åstrøm Section of Clinical and Experimental Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
  • Håvard Kjesbu Skjellegrind HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
  • Jūratė Šaltytė Benth The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
  • Øyvind Kirkevold The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Faculty of Health, Care and Nursing, NTNU Gjøvik, Gjøvik, Norway; The Norwegian National Centre for Ageing and Health, Tønsberg, Norway
  • Sverre Bergh The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; The Norwegian National Centre for Ageing and Health, Tønsberg, Norway
  • Bjørn Henning Grønberg Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway; Department of Oncology, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • Siri Rostoft Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
  • Asta Bye Oslo Metropolitan University, Oslo, Norway
  • Paul Jarle Mork Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  • Marit Slaaen The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

DOI:

https://doi.org/10.2340/sju.v59.18616

Keywords:

prostate cancer, radical treatment, quality of life, older patients

Abstract

Objective: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects.

Material and Methods: This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014–2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment.

Results: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min–max 44–84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] −0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance.

Conclusions: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Downloads

Download data is not yet available.

Author Biographies

Line Merethe Oldervoll, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre for Crisis Psychology, Faculty of Psychology University of Bergen, Bergen, Norway

More than one affiliation, please include:

Centre for Crisis Psychology, Faculty of Psychology University of Bergen, Bergen, Norway

Håvard Kjesbu Skjellegrind, HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

More than one affiliation, please include: 

Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

Jūratė Šaltytė Benth, The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway

More than one affiliation, please include: 

Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway

and:

Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway

Øyvind Kirkevold, The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Faculty of Health, Care and Nursing, NTNU Gjøvik, Gjøvik, Norway; The Norwegian National Centre for Ageing and Health, Tønsberg, Norway

More than one affiliation, please include: 

Faculty of Health, Care and Nursing, NTNU Gjøvik, Gjøvik, Norway

and:

The Norwegian National Centre for Ageing and Health, Tønsberg, Norway

Sverre Bergh, The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; The Norwegian National Centre for Ageing and Health, Tønsberg, Norway

More than one affiliation, please include:

The Norwegian National Centre for Ageing and Health, Tønsberg, Norway

Bjørn Henning Grønberg, Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway; Department of Oncology, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

More than one affiliation, please include: 

Department of Oncology, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

Siri Rostoft, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway

More than one affiliation, please include: 

Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway

Marit Slaaen, The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

More than one affiliation, please include: 

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

References

European Association of Urology: guidelines on Prostate Cancer 2023. [June 5th, 2023]. Available from: https://uroweb.org/guidelines/prostate-cancer

Lardas M, Liew M, van den Bergh RC, et al. Quality of life outcomes after primary treatment for clinically localised prostate cancer: a systematic review. Eur Urol. 2017 Dec;72(6):869–885.

https://doi.org/10.1016/j.eururo.2017.06.035 DOI: https://doi.org/10.1016/j.eururo.2017.06.035

Fossa SD, Dahl AA, Johannesen TB, et al. Late adverse health outcomes and quality of life after curative radiotherapy + long-term ADT in prostate cancer survivors: comparison with men from the general population. Clin Transl Radiat Oncol. 2022 Nov;37:78–84.

https://doi.org/10.1016/j.ctro.2022.08.003 DOI: https://doi.org/10.1016/j.ctro.2022.08.003

Luo YH, Yang YW, Wu CF, et al. Fatigue prevalence in men treated for prostate cancer: a systematic review and meta-analysis. World J Clin Cases. 2021 Jul 26;9(21):5932–5942.

https://doi.org/10.12998/wjcc.v9.i21.5932 DOI: https://doi.org/10.12998/wjcc.v9.i21.5932

Cancer Registry of Norway: Årsrapport 2021 med resultater og forbedringstiltak fra Nasjonalt kvalitetsregister for prostatakreft. Oslo; 2022 [cited 2023 Feb 13]. Available from: https://www.kreftregisteret.no/Generelt/Rapporter/Arsrapport-fra-kvalitetsregistrene/Arsrapport-fra-prostatacancerregisteret-/arsrapport-for-prostatakreft-2021/

Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in prostate cancer – 29-year follow-up. N Engl J Med. 2018 Dec 13;379(24):2319–2329.

https://doi.org/10.1056/NEJMoa1807801 DOI: https://doi.org/10.1056/NEJMoa1807801

Bekelman JE, Mitra N, Handorf EA, et al. Effectiveness of androgen-deprivation therapy and radiotherapy for older men with locally advanced prostate cancer. J Clin Oncol. 2015 Mar 1;33(7):716–722.

https://doi.org/10.1200/JCO.2014.57.2743 DOI: https://doi.org/10.1200/JCO.2014.57.2743

Aas K, Fossa SD, Åge Myklebust T, et al. Increased curative treatment is associated with decreased prostate cancer-specific and overall mortality in senior adults with high-risk prostate cancer; results from a national registry-based cohort study. Cancer Med. 2020 Sep;9(18):6646–6657.

https://doi.org/10.1002/cam4.3297 DOI: https://doi.org/10.1002/cam4.3297

Bratt O, Folkvaljon Y, Hjälm Eriksson M, et al. Undertreatment of men in their seventies with high-risk nonmetastatic prostate cancer. Eur Urol. 2015 Jul;68(1):53–58.

https://doi.org/10.1016/j.eururo.2014.12.026 DOI: https://doi.org/10.1016/j.eururo.2014.12.026

Löffeler S, Halland A, Fawad H, et al. Non-metastatic prostate cancer: rationale for conservative treatment and impact on disease-related morbidity and mortality in the elderly. Scand J Urol. 2020 Apr;54(2):105–109.

https://doi.org/10.1080/21681805.2020.1732463 DOI: https://doi.org/10.1080/21681805.2020.1732463

Sedrak MS, Freedman RA, Cohen HJ, et al. Older adult participation in cancer clinical trials: a systematic review of barriers and interventions. CA Cancer J Clin. 2021 Jan;71(1):78–92.

https://doi.org/10.3322/caac.21638 DOI: https://doi.org/10.3322/caac.21638

Marotte D, Chand-Fouche ME, Boulahssass R, et al. Irradiation of localized prostate cancer in the elderly: a systematic literature review. Clin Transl Radiat Oncol. 2022 Jul;35:1–8.

https://doi.org/10.1016/j.ctro.2022.04.006 DOI: https://doi.org/10.1016/j.ctro.2022.04.006

Seghers P, Wiersma A, Festen S, et al. Patient preferences for treatment outcomes in oncology with a focus on the older patient – a systematic review. Cancers (Basel). 2022; 14(5): 1147.

https://doi.org/10.3390/cancers14051147 DOI: https://doi.org/10.3390/cancers14051147

Fried TR, Bradley EH, Towle VR, et al. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002 Apr 4;346(14):1061–1066.

https://doi.org/10.1056/NEJMsa012528 DOI: https://doi.org/10.1056/NEJMsa012528

Ursem C, Diaz-Ramirez LG, Boscardin J, et al. Changes in functional status associated with radiation for prostate cancer in older veterans. J Geriatr Oncol. 2021;12(5):808–812.

https://doi.org/10.1016/j.jgo.2020.12.011 DOI: https://doi.org/10.1016/j.jgo.2020.12.011

Mandel P, Chandrasekar T, Chun FK, et al. Radical prostatectomy in patients aged 75 years or older: review of the literature. Asian J Androl. 2017 Sep 26;21(1):32–36.

https://doi.org/10.4103/aja.aja_43_17 DOI: https://doi.org/10.4103/aja.aja_43_17

Odeo S, Degu A. Factors affecting health-related quality of life among prostate cancer patients: a systematic review. J Oncol Pharm Pract. 2020 Dec;26(8):1997–2010.

https://doi.org/10.1177/1078155220959414 DOI: https://doi.org/10.1177/1078155220959414

Goineau A, Campion L, Commer JM, et al. Can comprehensive geriatric assessment predict tolerance of radiotherapy for localized prostate cancer in men aged 75 years or older? Cancers (Basel). 2020 Mar;12:635.

https://doi.org/10.3390/cancers12030635 DOI: https://doi.org/10.3390/cancers12030635

Togashi K, Hatakeyama S, Okamoto T, et al. Oncologic and patient-reported outcomes after robot-assisted radical prostatectomy in men aged ≥75 years. Urol Oncol. 2021 Oct;39(10):729.e17–729.e25.

https://doi.org/10.1016/j.urolonc.2020.12.001 DOI: https://doi.org/10.1016/j.urolonc.2020.12.001

Hampson LA, Cowan JE, Zhao S, et al. Impact of age on quality-of-life outcomes after treatment for localized prostate cancer. Eur Urol. 2015 Sep;68(3):480–486.

https://doi.org/10.1016/j.eururo.2015.01.008 DOI: https://doi.org/10.1016/j.eururo.2015.01.008

Posielski N, Frankel J, Kuo HC, et al. Impact of age and race on health-related quality of life outcomes in patients undergoing radical prostatectomy for localized prostate cancer. Urology. 2022 May;163:99–106.

https://doi.org/10.1016/j.urology.2021.07.034 DOI: https://doi.org/10.1016/j.urology.2021.07.034

Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365–376.

https://doi.org/10.1093/jnci/85.5.365 DOI: https://doi.org/10.1093/jnci/85.5.365

Szymanski KM, Wei JT, Dunn RL, et al. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology. 2010 Nov;76(5):1245–1250.

https://doi.org/10.1016/j.urology.2010.01.027 DOI: https://doi.org/10.1016/j.urology.2010.01.027

Fossa SD, Storas AH, Steinsvik EA, et al. Psychometric testing of the Norwegian version of the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26). Scand J Urology. 2016 Aug;50(4):280–285.

https://doi.org/10.3109/21681805.2016.1163617 DOI: https://doi.org/10.3109/21681805.2016.1163617

King MT. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res. 1996 Dec;5(6):555–567.

https://doi.org/10.1007/BF00439229 DOI: https://doi.org/10.1007/BF00439229

Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998 Jan;16(1):139–144.

https://doi.org/10.1200/JCO.1998.16.1.139 DOI: https://doi.org/10.1200/JCO.1998.16.1.139

Fossa SD, Hess SL, Dahl AA, et al. Stability of health-related quality of life in the Norwegian general population and impact of chronic morbidity in individuals with and without a cancer diagnosis. Acta Oncol. 2007;46(4):452–461.

https://doi.org/10.1080/02841860601182641 DOI: https://doi.org/10.1080/02841860601182641

Skolarus TA, Dunn RL, Sanda MG, et al. Minimally important difference for the expanded prostate cancer index composite short form. Urology. 2015 Jan;85(1):101–105.

https://doi.org/10.1016/j.urology.2014.08.044 DOI: https://doi.org/10.1016/j.urology.2014.08.044

Sundararajan V, Henderson T, Perry C, et al. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004 Dec;57(12):1288–1294.

https://doi.org/10.1016/j.jclinepi.2004.03.012 DOI: https://doi.org/10.1016/j.jclinepi.2004.03.012

Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.

https://doi.org/10.1016/0021-9681(87)90171-8 DOI: https://doi.org/10.1016/0021-9681(87)90171-8

Kurian CJ, Leader AE, Thong MSY, et al. Examining relationships between age at diagnosis and health-related quality of life outcomes in prostate cancer survivors. BMC Public Health. 2018 Aug 23;18(1):1060.

https://doi.org/10.1186/s12889-018-5976-6 DOI: https://doi.org/10.1186/s12889-018-5976-6

Lemanska A, Dearnaley DP, Jena R, et al. Older age, early symptoms and physical function are associated with the severity of late symptom clusters for men undergoing radiotherapy for prostate cancer. Clin Oncol (R Coll Radiol). 2018 Jun;30(6):334–345.

https://doi.org/10.1016/j.clon.2018.01.016 DOI: https://doi.org/10.1016/j.clon.2018.01.016

Namiki S, Ishidoya S, Kawamura S, et al. Quality of life among elderly men treated for prostate cancer with either radical prostatectomy or external beam radiation therapy. J Cancer Res Clin Oncol. 2010 Mar;136(3):379–386.

https://doi.org/10.1007/s00432-009-0665-6 DOI: https://doi.org/10.1007/s00432-009-0665-6

Holze S, Bräunlich M, Mende M, et al. Age-stratified outcomes after radical prostatectomy in a randomized setting (LAP-01): do younger patients have more to lose? World J Urol. 2022;40(5):1151–1158.

https://doi.org/10.1007/s00345-022-03945-0 DOI: https://doi.org/10.1007/s00345-022-03945-0

World Health Organization – WHOQOL: measuring quality of life [December 4th, 2023]. Available from: https://www.who.int/tools/whoqol

Liang Y, Rausch C, Laflamme L, et al. Prevalence, trend and contributing factors of geriatric syndromes among older Swedes: results from the Stockholm County Council Public Health Surveys. BMC Geriatr. 2018 Dec 29;18(1):322.

https://doi.org/10.1186/s12877-018-1018-6 DOI: https://doi.org/10.1186/s12877-018-1018-6

Boyle HJ, Alibhai S, Decoster L, et al. Updated recommendations of the International Society of Geriatric Oncology on prostate cancer management in older patients. Eur J Cancer. 2019 Jul;116:116–136.

https://doi.org/10.1016/j.ejca.2019.04.031 DOI: https://doi.org/10.1016/j.ejca.2019.04.031

Downloads

Published

2024-02-20

How to Cite

Sletten, R., Berger Christiansen, O., Oldervoll, L. M., Åstrøm, L., Kjesbu Skjellegrind, H., Šaltytė Benth, J., Kirkevold, Øyvind, Bergh, S., Grønberg, B. H., Rostoft, S., Bye, A., Mork, P. J., & Slaaen, M. (2024). The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study. Scandinavian Journal of Urology, 59, 31–38. https://doi.org/10.2340/sju.v59.18616

Issue

Vol. 59 (2024)

Section

Original research article

License

Copyright (c) 2024 Reidun Sletten, Ola Berger Christiansen, Line Merethe Oldervoll, Lennart Åstrøm, Håvard Kjesbu Skjellegrind, Jūratė Šaltytė Benth, Øyvind Kirkevold, Sverre Bergh, Bjørn Henning Grønberg, Siri Rostoft, Asta Bye, Paul Jarle Mork, Marit Slaaen

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.

Crossref
Scopus
Google Scholar
Europe PMC

Funding data