Abstract
Abstract only
9601
Background: The equivalence of surgery (RP), external beam radiation (EBRT), and expectant management (EM) on overall survival of prostate cancer (PCa) patients and their respective impact on health-related quality of life (HRQoL) is controversial. Thus, the benefit of screening has been raised. There is a scarcity of information on demographic factors that influence patient treatment choice and the resulting impact treatment has on HRQoL. Methods: Patients presenting to an equal access military multi-disciplinary PCa clinic are enrolled in a HRQoL database after informed consent. Surveys are administered prior to treatment and at 3, 6, 9, and 12 months. The instruments are the EPIC, EPIC Demographic, and the MOS Short-Form 36. Chi-square analysis compared frequency of race, income, and education level by treatment choice. Multivariate analysis was used to predict changes in HRQoL outcomes over time. Results: The study consisted of 538 patients. Caucasians chose EM twice as frequently as African Americans (AA) (p=0.0033). Caucasians were 3 times more likely to choose RP over EBRT, whereas AA were more evenly divided. Patients who earned over $100,000 annually disproportionately chose RP while the other treatment groups were disproportionately represented by those earning less than $100,000 (p<0.0001). Those having a graduate school degree disproportionately chose RP while the other treatment options were disproportionately represented in those with college education or less (p<0.0001). Mean age for RP, EBRT, and EM was 58, 67, and 69 respectively. Patients undergoing RP had significantly worse HRQoL outcomes in the following domains: urinary function, sexual function, and sexual bother at 12 months despite having the highest baseline scores (p<0.0001). The only domain that differed between patients undergoing EBRT and EM was bowel bother (p<0.0001). Conclusions: Patients choosing RP tend to be younger Caucasians with higher income and educational levels. This cohort chose the option with the greatest impact on HRQoL, which gives evidence that patients with certain demographics may emphasize other factors in their treatment decisions. HRQoL between EBRT and EM differed in only one domain. EBRT may be offered to older patients with minimal HRQoL impact.
No significant financial relationships to disclose.