Quality of life in men living with advanced and localised prostate cancer: A United Kingdom population-wide patient-reported outcome study of 30,000 men

This Journal article is part of Staff Publications

This publication is embargoed and will be available as Open Access on 2019-07-31.

Manuscript details


Background. Little is known about the health-related quality of life (HRQL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQL in men with all stages of prostate cancer, and identify implications for healthcare delivery. Methods. Men alive 18-42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered which contained validated measures to assess a) functional outcomes (EPIC-26 plus use of interventions for sexual dysfunction) and b) generic HRQL (EQ-5D-5L & self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQL across diagnostic stage and self-reported treatment groups. Findings. 35,823 (60.8%) men responded. Stage was known for 85.8%; 19,599 (63.8%) stage I/II, 7,209 (23.4%) stage III, 3,925 (12.8%) stage IV. Functional outcomes: Poor sexual function was common (81.0%), regardless of stage, and over half of men (55.8%) received no intervention for this. Differences in urinary and bowel morbidity were greater with respect to treatment than stage. In men treated with androgen deprivation therapy (ADT), 30.7% reported moderate/big problems with hot flushes, 29.4% with lack of energy and 22.5% with weight gain. HRQL: Overall self-assessed health was similar in men with stage I-III disease, and whilst reduced in those with stage IV cancer, 23.5% with metastatic disease reported no problems on any EQ-5D dimension. Interpretation. Men diagnosed with advanced disease do not report markedly different HRQL outcomes to those diagnosed with localised disease, although substantial problems with hormonal function and fatigue are reported amongst men treated with ADT. Sexual dysfunction is common and the majority of men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the impact of ADT are required.


Amy Downing
Penny Wright
Luke Hounsome
Peter Selby
Sarah Wilding
Eila Watson
Richard Wagland
Paul Kind
David W. Donnelly
Hugh Butcher
James W.F. Catto
William Cross
Malcolm Mason
Linda Sharp
David Weller
Galina Velikova
Eilis McCaughan
Rebecca Mottram
Majorie Allen
Therese Kearney
Oonagh McSorley
Dyfed W. Huws
David H. Brewster
Emma McNair
Anna Gavin
Adam W. Glaser


Faculty of Health and Life Sciences

Version of record




Downing, A., Wright, P., Hounsome, L., Selby, P., Wilding, S., Watson, E., Wagland, R., Kind, P., Donnelly, D., Butcher, H., Catto, J., Cross, W., Mason, M., Sharp, L., Weller, D., Velikova, G., McCaughan, E., Mottram, R., Allen, M., Kearney, T., McSorley, O., Huws, D., Brewster, D., McNair, E., Gavin, A. and Glaser, A. () 'Quality of life in men living with advanced and localised prostate cancer: A United Kingdom population-wide patient-reported outcome study of 30,000 men', Lancet Oncology. DOI: 10.1016/S1470-2045(18)30780-0.