uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Long-term Distress After Radical Prostatectomy Versus Watchful Waiting in Prostate Cancer: A Longitudinal Study from the Scandinavian Prostate Cancer Group-4 Randomized Clinical Trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Regional Cancer Center, Uppsala-Örebro, Uppsala, Sweden.
King's College London, Medical School, Division of Cancer Studies, London, UK.
Show others and affiliations
2013 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 64, no 6, 920-928 p.Article in journal (Refereed) Published
Abstract [en]


Studies enumerating the dynamics of physical and emotional symptoms following prostate cancer (PCa) treatment are needed to guide therapeutic strategy. Yet, overcoming patient selection forces is a formidable challenge for observational studies comparing treatment groups.


To compare patterns of symptom burden and distress in men with localized PCa randomized to radical prostatectomy (RP) or watchful waiting (WW) and followed up longitudinally.


The three largest, Swedish, randomization centers for the Scandinavian Prostate Cancer Group-4 trial conducted a longitudinal study to assess symptoms and distress from several psychological and physical domains by mailed questionnaire every 6 mo for 2 yr and then yearly through 8 yr of follow-up.


RP compared with WW.


A questionnaire was mailed at baseline and then repeatedly during follow-up with questions concerning physical and mental symptoms. Each analysis of quality of life was based on a dichotomization of the outcome (yes vs no) studied in a binomial response, generalized linear mixed model.


Of 347 randomized men, 272 completed at least five questionnaires during an 8-yr follow-up period. Almost all men reported that PCa negatively influenced daily activities and relationships. Health-related distress, worry, feeling low, and insomnia were consistently reported by approximately 30-40% in both groups. Men in the RP group consistently reported more leakage, impaired erection and libido, and fewer obstructive voiding symptoms. For men in the WW group, distress related to erectile symptoms increased gradually over time. Symptom burden and distress at baseline was predictive of long-term outlook.


Cancer negatively influenced daily activities among almost all men in both treatment groups; health-related distress was common. Trade-offs exist between physiologic symptoms, highlighting the importance of tailored treatment decision-making. Men who are likely to experience profound long-term distress can be identified early in disease management.

Place, publisher, year, edition, pages
2013. Vol. 64, no 6, 920-928 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-211157DOI: 10.1016/j.eururo.2013.02.025ISI: 000326678100010PubMedID: 23465517OAI: oai:DiVA.org:uu-211157DiVA: diva2:665606
Available from: 2013-11-20 Created: 2013-11-20 Last updated: 2013-12-09Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Bill-Axelson, AnnaGarmo, HansHolmberg, LarsJohansson, Eva
By organisation
UrologyUCR-Uppsala Clinical Research Center
In the same journal
European Urology
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 270 hits
ReferencesLink to record
Permanent link

Direct link