Introduction.

An important issue the scientific community addressed is the investigation of the

Health- Related Quality of Life (HRQoL) in patients with localized prostate cancer (PCa)
who opted for AS. The level of HRQoL during AS sometimes was called into question,
but several studies highlighted that most of patients on AS did not experience a
decrease of psychological wellbeing (van Den Bergh, 2012). The goal of the present
study is to monitor HRQoL over time for those patients who, after being enrolled in AS,
for either clinical or personal reasons switched to an active treatment.
Patients and Methods.
43 patients who discontinued the Active Surveillance protocols were enrolled in the
present study. All of them received by regular mail or email (according to individual
preferences) the questionnaire assessing HRQoL together with forms collecting clinical
information about treatment, drugs and tests run after exiting AS. Furthermore, they
previously had accepted to participate in an ancillary HRQoL study and thus they had
undergone an initial assessment of HRQoL at enrollment in AS and after a 10-months
period from diagnostic biopsy, about 2 months before the first re-biopsy. Therefore,
data on HRQoL were collected at three time points. HRQoL was measured by the
Functional Assessment of Cancer Therapy scale - Prostate Version (FACT-P). In order to
detect changes over time, Friedman non parametric tests were conducted for each of
the FACT-P subscales: functional wellbeing (FWB), emotional wellbeing (EWB), prostate
cancer symptoms (PCS), physical wellbeing (PWB), social wellbeing (SWB).
Results
The mean age of the study population was 71 years (SD=6.58; range: 57-81). Table 1
illustrates descriptive normalized scores for FACT-P at the enrolment (T0), after 10
months from the diagnostic biopsy (T1), and after the discontinuation of the AS
protocol (T2).
The results showed that:
-

Prostate cancer symptoms (PCS) decreased in T2 with respect to T0 and T1

(F2,84=4.74; p=0.011);
Physical well-being (PWB) changed over time, and in particular it was lower
after AS discontinuation compared to T0 and T1 (F2,84=5.14; p=0.08);
Social well-being (SWB) was lower in T2 compared to T0 but not to T1
(F2,82=3.41; p=0.038).

FWB and EWB did not show any change over time.
Discussion & Conclusions
The present study illustrates how the different dimensions of HRQoL change over time
considering three time points very important for patients who chose AS and then
discontinued the observational approach switching to an active treatment: the
enrolment in AS protocol, the period preceding the first biopsy and after the
discontinuation of the AS protocol. According to the present findings, changes have
been detected with respect to the physical and social wellbeing and the treatment
symptoms, which appear affected after exiting AS compared to the previous time

points. This result makes sense if we think that all the patients in T2 had already
undergone an active treatment and may be they bear the related side effects.
In conclusion, the present study suggests that, in PCa patients who opted for AS and
then switched to an active treatment, the critical point, potentially harmful for at least
some dimensions of HRQoL, is the period after the discontinuation of the AS protocol.
This result suggests that these patients may deserve clinical and psychological
support to overcome physical impairments and social issues, in order to help them
finding a new and integrated psychophysical balance.
Acknowledgements to Foundations I. Monzino.
Van Den Bergh et al., Curr Opin Urol, 2012