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Abstract
Aim To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations.
Participants PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI).
Method A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression.
Results 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score.
Conclusions Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.
- Prostate Cancer
- Survivors
- Patient Reported Outcomes
- PSA Testing
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Footnotes
Contributors ATG, LS and CD were involved in conception of study, funding and ethics. ATG and DD were involved in data analysis. FJD, ATG, LS and GJG were involved in study organisation. All authors were involved in data interpretation and write-up.
Funding The N. Ireland Cancer Registry is funded by the Public Health Agency for Northern Ireland. This study was funded by Prostate cancer UK (N109–03 and NI-PG13–01), Research and Development Office Northern Ireland, the Health Research Board (HRA_HSR/2010/17) with supplemental funding provided by the National Cancer Control Programme in RoI.
Competing interests LS received an unrestricted grant 2011–2012 from Sanofi-aventis for research into predictors of treatment receipt and survival in prostate cancer.
Ethics approval Research Ethics Committees for NI (ORECNI), 10/NIR03/61.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from this research are available in anonymised format for specified research proposals by emailing a.gavin@qub.ac.uk. The release of data will be conditional on assurance from the secondary researcher that the proposed use of the data is compliant with the MRC Policy on Data Preservation and Sharing regarding scientific quality, ethical requirements and value for money. A minimum requirement with respect to scientific quality will be a protocol describing the purpose, methods and analysis of the secondary research. Results were disseminated to participants on request and are available via Prostate Cancer UK and NICR websites.
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