Boyko A. I., Reznik V. O.

DYNAMICS OF QUALITY OF LIFE AND FUNCTIONAL STATUS IN PATIENTS AFTER RADICAL PROSTATECTOMY ASSESSED USING THE EORTC QLQ-C30: AN AGE-STRATIFIED ANALYSIS

---

Show/Download

About the author:

Boyko A. I., Reznik V. O.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

Prostate cancer remains one of the major oncological challenges in men, and radical prostatectomy (RP) is one of the key treatment modalities with curative intent. However, in contemporary clinical practice, the effectiveness of RP cannot be assessed solely on the basis of oncological criteria, including prostate-specific antigen (PSA) control, biochemical recurrence, and surgical margin status. From the patient’s perspective, functional outcomes, including physical activity, self-care, and role functioning, as well as symptom burden are of critical importance, as they determine the return to usual daily activities, social roles, and work capacity. Therefore, assessment of quality of life (QoL) is recommended as an essential component of a comprehensive evaluation of treatment outcomes. The aim of the study was to determine the patterns and age-related differences in the dynamics of QoL and functional status in patients after RP by analyzing EORTC QLQ-C30 scores. A total of 214 patients with prostate cancer who underwent RP using laparoscopic techniques were examined. Of these, 63 (29.6%) underwent laparoscopic radical prostatectomy (LRP), while 151 (70.4%) underwent endovideoscopic extraperitoneal radical prostatectomy (EERP). QoL and functional status were assessed using the EORTC QLQ-C30 at three time points: before surgery (T0), 6 months after RP (T6), and 12 months after RP (T12). Scale directionality was taken into account when interpreting the results: for the functional items C30_01–C30_07, higher scores indicated better functioning, whereas for the symptom items C30_08–C30_12, higher scores indicated worse health status, corresponding to greater symptom severity. For C30_01 and C30_02, a significant decrease was observed at T6 in many subgroups, followed by a shift toward higher scores at T12, reflecting improved physical functioning in a proportion of patients. A similar pattern was observed for items reflecting limitations in daily activities and leisure activities (C30_06–C30_07): following a decline at T6, scores stabilized or partially increased by T12. Importantly, recovery at T12 did not necessarily indicate a complete return to baseline. For several items, the T0:T12 comparison remained statistically significant, indicating residual impairment in functioning even at the end of the follow-up period. The symptom items (C30_08–C30_12) generally demonstrated a mirror-image pattern: symptom scores tended to increase at T6, indicating greater symptom severity, followed by a reduction in symptom burden at T12. This pattern was particularly evident for pain and asthenic symptoms. For C30_09 (pain), a substantial increase was observed at T6 in some subgroups, followed by a decrease at T12. Similarly, C30_10 (need for rest) and C30_12 (weakness) frequently showed a peak in symptom severity at T6, followed by a marked regression at T12. C30_11 (sleep disturbances) exhibited a similar pattern, with symptoms worsening at the intermediate time point and decreasing by T12, although changes in some subgroups did not reach statistical significance. The data clearly demonstrate that both comparisons – T0:T6 (deterioration) and T6:T12 (improvement) – were frequently statistically significant for the symptom items, highlighting a phased rather than monotonic pattern over time. Thus, in the 214 patients who underwent RP, EORTC QLQ-C30 scores demonstrated a phased (“wave-like”) pattern over time, with the poorest outcomes most frequently observed at 6 months, followed by improvement at 12 months, although a complete return to preoperative levels was not always achieved. The functional domains (C30_01–C30_07) were most affected during the first 6 months after RP, as reflected by reduced daily activity and role functioning, whereas the symptom domains (C30_08–C30_12) were characterized by a peak in symptom burden during the same period, followed by regression by 12 months. Pronounced age-related differences were identified: patients in older age groups generally exhibited more substantial deterioration at 6 months and less consistent recovery by 12 months, underscoring the need for individualized rehabilitation strategies. The period around 6 months after RP appears to be the most clinically vulnerable in terms of QoL and symptom burden and should therefore be considered a priority period for active postoperative management, including pain control, management of fatigue and sleep disturbances, and prevention of physical deconditioning, particularly in older patients.

Tags:

Bibliography:

1. Cornford P, Tilki D, van den Bergh RCN, Eberli D, Fonteyne V, Gandaglia G, et al. Quality of life outcomes in prostate cancer. In: EAUEANM- ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Arnhem: European Association of Urology; 2026. p. 157-168. Available from: https://uroweb.org/guidelines/prostate-cancer/chapter/quality-of-life-outcomes-in-prostate-cancer
2. Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al. EAU-EANM-ESTRO-ESUR-ISUPSIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024;86(2):148-63. DOI: http://doi.org/10.1016/j.eururo.2024.03.027
3. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365-76. DOI: http://doi.org/10.1093/jnci/85.5.365
4. Fayers P, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A. EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels: EORTC Quality of Life Group; 2001. 78 p. Available from: https://www.eortc.org/app/uploads/sites/2/2018/02/SCmanual.pdf
5. US Department of Health and Human Services FDA Center for Drug Evaluation and Research; US Department of Health and Human Services FDA Center for Biologics Evaluation and Research; US Department of Health and Human Services FDA Center for Devices and Radiological Health. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes. 2006;4:79. DOI: http://doi.org/10.1186/1477-7525-4-79
6. Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013;368(5):436-45. DOI: http://doi.org/10.1056/NEJMoa1209978
7. Lardas M, Liew M, van den Bergh RC, De Santis M, Bellmunt J, Van den Broeck T, et al. Quality of Life Outcomes after Primary Treatment for Clinically Localised Prostate Cancer: A Systematic Review. Eur Urol. 2017;72(6):869-85. DOI: http://doi.org/10.1016/j.eururo.2017.06.035
8. Fox L, van Leeuwen M, Jones JM, Al-Omari A, Abaza H, Al-Khaifi M, et al. International phase IV field study to validate the European Organisation for Research and Treatment of Cancer questionnaire for assessing the health-related quality of life of cancer survivors: The EORTC QLQ-SURV100. Eur J Cancer. 2026;245:116959. DOI: http://doi.org/10.1016/j.ejca.2026.116959
9. Seputra KP, Daryanto B, Budaya TN, Satyagraha P, Purnomo AF, Rofifa AF, et al. Quality of Life in Prostate Cancer Patients Following Radical Prostatectomy: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev. 2025;26(9):3185-92. DOI: http://doi.org/10.31557/APJCP.2025.26.9.3185
10. Anguas-Gracia A, Antón-Solanas I, Echániz-Serrano E, Subirón-Valera AB, Rodríguez-Roca B, Juárez-Vela R, et al. Quality of Life after Radical Prostatectomy: A Longitudinal Study. Nurs Rep. 2023;13(3):1051-63. DOI: http://doi.org/10.3390/nursrep13030092

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 210-217 pages, index UDC 616.65-006.6-089.87:616-036.8:159.9

DOI:

10.29254/2077-4214-2026-3-182-210-217