Purpose: Treatments for prostate cancer are comparable in long-term outcome; however are associated with different health-related quality of life (HRQoL) outcomes, including erectile dysfunction (ED). We compare changes in sexual function (SF) and bother (SB) scores from pretreatment baseline to 3 month intervals for up to 13.5 years by treatment, risk and age and compare costs of ED treatment among those who decline, don’t change or improve in SF and SB.
Method: Treatment, healthcare use and outcome data came from CaPSURE a national disease registry with 3,276 men with prostate cancer from 31 urology practices who completed patient-reported outcomes questionnaires including risk, healthcare utilization and HRQOL. SF and SB scores (0-100) were measured by the UCLA Prostate Cancer Index. A meaningful change was defined as 0.5 change in standard deviation from patient’s baseline score. The lowest average wholesale price was applied to all ED drugs. Mean ED drug costs every 3-months were stratified by change in SF and SB scores and compared across treatments with ANOVA. Bootstrapped regression determined factors predicting ED treatment costs.
Result: Of the total sample, 62% had prostatectomy, 48% were low risk with PSA 7.6, and were 64 years. Baseline SF score was 53.8 and SB was 62.3. Overall 65% reported decline in SF and 59% in SB. This proportion declining from pretreatment, decreased to 58% (SF) and 50% (SB) at 2 years. Total mean 6 month ED drug costs is $287.00 (95%CI=$193.54-$380.67). Cost was highest ($359) for open prostatectomy, lowest for watchful waiting (WW)($11). Costs were significantly lower for robotic compared with open prostatectomy (p<0.001) and significantly different across treatments for those who decline in SF (p=0.0008) and SB (p=0.0002). Age and risk were not predictors of ED costs. Type of treatment was the strongest predictor with robotic prostatectomy ED costs $274, Brachy $245, and WW $347 lower than open prostatectomy. Those with SF improvement had $170 lower ED costs than those who declined (p=0.065).
Conclusion: Treatment choice is the strongest predictor of 6 month post-treatment ED drug costs and open prostatectomy had the highest costs. Robotic had considerably lower ED costs than open prostatectomy. SF had a stronger influence on ED cost than SB. These results can guide physicians and patients when deciding on PC therapies.
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