Effect of prostate cancer investigation and treatment intensity on reported long term physical condition and health related quality of life: a two country study

Anna GAVIN, Queen's University Belfast, United Kingdom
DONNELLY D. 2 , DONNELLY C. 1 , MORGAN E. 1 , GORMLEY G. 3 , SHARP L. 4

1 N. Ireland Cancer Registry, Queen's University Belfast, Belfast, N.Ireland
2 Northern Ireland Statistics and Research Agency, Belfast, N. Ireland
3 Department of General Practice, Queen's University Belfast, N. Ireland
4 Institue of Health and Society, University of Newcastle, Newcastle, United Kingdom

Introduction
Ireland has since 1994, higher levels of PSA testing and Prostate Cancer (PCa) in Republic of Ireland (ROI) compared with N. Ireland (NI).  We investigate, health effects of different intensities of PCa investigation and treatment.
Method
Postal questionnaires to PCa survivors 2-18 years post diagnosis on physical symptoms and Health Related Quality of Life (HRQoL) at questionnaire completion. Survivors were analysed separately for ROI and NI, for categories at diagnosis ‘late disease’ defined as stage III/IV and any Gleason Grade (GG) and ‘early disease’ defined as stage I/II and GG 2-7.   Data were weighted by age, jurisdiction and time since diagnosis.  Univariate and multivariate results are presented.
Results
3,348 (54%) men responded. ROI responders were younger (average age diagnosis 65.3 vs 67.1 years); more likely to present asymptomatically (66% vs 41%); without comorbidities (45% vs 58%) and with early disease. Urinary  incontinence was (16%) similar in early and late group for NI and ROI, impotence similar for NI and ROI, lower in early than late disease (56% vs 67%). In early disease, only bowel problems (NI=21%, ROI=12%) and fatigue (NI=29%, ROI=17%) were significantly different. Multivariate modelling explained fatigue as treatment related.  
In late disease NI vs ROI men reported higher levels of breast changes (23% vs 9%) and  hot flashes (41% vs 19%) which remained in multivariate modelling however, when men on ADT were analysed separately no significant differences remained. Differences in HRQoL were minimal.
Conclusion
Similar health outcomes were reported however  the increased intensity of investigation has resulted in additional men with ongoing incontinence and/or impotence in ROI.