Changes in quality of life and lower urinary tract symptoms over time in cancer patients after a total prostatectomy: systematic review and meta-analysis

Abstract

This study aimed to clarify associations between and changes over time in lower urinary tract symptoms (LUTS) and quality of life (QOL) in cancer patients after a total prostatectomy. The subjects were cancer patients who had undergone total prostatectomy and had participated in non-randomized controlled trials, cohort studies, or case-control studies with outcomes of changes over time in LUTS or QOL. Fourteen studies were included for systematic review and meta-analysis. Compared to preoperatively, the International Prostate Symptom Score (IPSS)—a LUTS indicator—yielded the following, 3 months after operation (MD [95% confidence interval, CI]\u2009=\u2009−0.27 [−2.22 to 1.68], p\u2009=\u2009.7855), 6 months after operation (MD [95% CI]\u2009=\u2009−2.12 [−3.04 to −1.20], p\u2009<\u2009.0001), and 12 months after operation (MD [95% CI]\u2009=\u2009−2.27 [−2.63 to −1.92], p\u2009<\u2009.0001), demonstrating significant decrease and, therefore, improvement of symptoms after 6 months. International Prostate Symptom Score—Quality of Life (IPSS-QOL), a QOL indicator, was significantly reduced at 12 months after surgery, indicating improved QOL (MD [95% CI]\u2009=\u2009−0.49 [−0.87 to −0.11], p\u2009=\u2009.0107), but there was heterogeneity between different studies (I2\u2009=\u200989.19%). A cumulative meta-analysis showed a tendency for greater improvements in IPSS-QOL at 12 months after surgery, the older the mean age and the higher the mean pre-surgery IPSS. Factors of age, prostate volume, and pre-surgery IPSS were related to postoperative LUTS; exacerbation of both urinary incontinence and urinary tract obstruction was related to QOL. While LUTS improves over time after total prostatectomy, it takes 6 to 12 months after surgery. As there is an association between LUTS and QOL, support to promote self-management of LUTS is important.