Depression, anxiety, and health related quality of life following radical prostatectomy and radiation treatment: 12 month outcomes in a South African cohort.

内容摘要

Longitudinal patient-reported outcomes comparing radical prostectomy (RP) and radiation (RT) for localized prostate cancer (CaP) in low- to middle- income countries are limited. We examined the comparative course of depression and anxiety and their association with health related quality of life (HRQOL) in men treated with RP or RT over a year post-treatment. Data from 161 South African (SA) men with CaP were analysed. Depression, Anxiety, HRQOL, and relevant covariates were measured at baseline, 3, 6, 9, and 12&#xa0;months. We used the following validated scales: Centre for Epidemiologic Studies Depression (CES-D), State Trait Anxiety Inventory (STAI-S), European Organisation for Research and Treatment in Cancer Quality of Life (EORTC QLQ-PR25), Multidimensional Scale of Perceived Social Support (MSPSS), Memorial Anxiety Scale for Prostate Cancer (MAX-PC), Connor-Davidson Resilience Scale (CD-RISC), and Decisional Conflict Scale (DCS). Depressive symptoms (CES-D&#x2009;&#x2265;&#x2009;16) remained elevated 12&#xa0;months post-RP (baseline: 43%; 3-month: 37%; 6-month: 47%; 12-month: 42%), while RT prevalence declined (39% to 29%). Similarly, anxiety (STAI-S&#x2009;&#x2265;&#x2009;39) was more prevalent and persistent in the RP group (29% to 23%; 6-month peak: 28%) compared to the RT group (26% to 15%), where scores consistently declined throughout the first year. Overall urinary morbidity was marked in the first six months (&#x3b2;&#x2009;=&#x2009;11.828; 95% CI: 7.931to 15.73; p&#x2009;<&#x2009;0.001). More men in the RP group exhibited higher incontinence aids use (&#x3b2;&#x2009;=&#x2009;-21.477; 95% CI: to 33.261 to 9.694; p&#x2009;<&#x2009;0.001). Sexual function in RP was lower (&#x3b2;&#x2009;=&#x2009;18.006; 95% CI: 6.881 to 29.131; p&#x2009;=&#x2009;0.002) with increased sexual activity from month nine onwards (&#x3b2;&#x2009;=&#x2009;-13.203; 95% CI: -23.489 to -2.916; p&#x2009;=&#x2009;0.012). RT was associated with bowel symptoms in the latter half of follow-up. (4.681; 95% CI: 0.702 to 8.659; p&#x2009;=&#x2009;0.021). Depression and anxiety adversely affected all HRQOL functional and symptom domains except sexual activity. The high prevalence of depression and anxiety reflects marked psychological morbidity in men treated for CaP in the first year post-treatment. Given the substantial association between psychological impairment and HRQOL, integrating mental health screening, management and referral into uro-oncology protocols is critical.