Quality of life in prostate cancer: active surveillance versus radical prostatectomy
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Introduction: This purpose of this review is to summarize current literature surrounding quality of life research in men with prostate cancer who choose either active surveillance (AS) or radical prostatectomy (RP), targeting anxiety, urinary and sexual symptoms. Methods: A PUBMED search on anxiety, urinary, and sexual symptoms in active surveillance and prostatectomy in prostate cancer was performed using MESH search terms. Literature in English from 2005 to 2015 was included, and augmented with relevant articles found amongst reference lists. Thirteen original research articles were selected for review. Results: Men in AS vs RP groups do not significantly differ in terms of anxiety, depression or distress. A higher proportion of men have difficulty achieving erections firm enough for intercourse and higher rates of urinary incontinence after RP. No data was found comparing urinary obstructive symptoms in RP and AS, though obstructive symptoms are known to be higher in watchful waiting. Conclusion: Active surveillance is advantageous in having lower rates of erectile dysfunction and urinary incontinence, and is not associated with higher rates of anxiety. There are few studies comparing health related quality of life in active surveillance to radical prostatectomy, and more literature is required to fully understand the quality of life outcomes of each treatment choice.