Introduction:

Treatment of localized prostate cancer (PCa) results in varying adverse effects on Health-Related Quality of Life (HRQoL). African American (AA) men have higher incidence and PCa mortality than men of other races, but little is known about differences in HRQoL after PCa treatment. We examined racial differences in treatment patterns and HRQoL in men undergoing active surveillance (AS), radical prostatectomy (RP), or radiation therapy (XRT) in a racially diverse cohort with durable follow up.

Methods:

Men diagnosed with low or intermediate risk PCa from 2007-2017 in the multicenter Center for Prostate Disease Research Database were identified. HRQoL at baseline and yearly for 5 years was evaluated using the Expanded PCa Index Composite (EPIC) and 36 Item Short Form Health Survey (SF-36). Temporal changes in HRQoL were assessed using linear regression models adjusting for baseline HRQoL, demographics, and clinical characteristics. Treatment patterns and HRQoL for AA and non-AA men were compared and assessed individually.

Results:

Of 1006 men included, 223 (22.1%) were AA. Mean follow-up was 5.3 years. AA men with low-risk disease were less likely to undergo AS (28.5 vs. 38.8%) and more likely to undergo XRT (22.3 vs. 10.6%) than non-AA men, p<0.001. In intermediate-risk disease, AA received more XRT (43.0 vs. 26.9%) while rates of RP were lower (50.5 vs 66.8%), p=0.016. (Figure1)

            HRQoL was compared for each treatment between AA and non-AA men. No racial differences were found in urinary, bowel, sexual or hormonal scores for AS, RP or XRT. SF-36 physical and mental component scores were similar.

            Within racial group comparisons were then performed. In both AA and non-AA men, RP resulted in worse urinary function and sexual function/bother compared to AS and XRT. Bowel HRQoL was similar by treatment modality in AA men, however, in non-AA men, XRT resulted in worse bowel scores compared to AS and RP. (Figure2)

Conclusion:

AA men are less often treated with AS for low-risk disease and are more likely to undergo XRT in both low- and intermediate-risk. HRQOL outcomes for individual treatment modalities are similar between races, however, the effect of XRT on bowel symptoms as compared to AS and RP may be worse in non-AA men. Further study is needed to understand the impact of HRQoL on treatment patterns in localized PCa.

Funding: N/a