Abstract

Prostate cancer outcomes research incorporates a broad spectrum of endpoints, from clinical or intermediate endpoints, such as tumor shrinkage or patient compliance, to final endpoints, such as survival or disease-free survival. Three types of nontraditional endpoints that are of growing interest—health-related quality of life (QOL), satisfaction with care, and economic cost impact—hold the promise of improving our ability to understand the full burden of prostate cancer screening and treatment. In this article we review the last decade's published literature regarding the health-related QOL, satisfaction, and economic outcomes of prostate cancer screening and treatment to determine the “state of the science” of outcomes measurement. The focus is the enumeration of the types of outcome measurement used in the studies not the determination of the results of the studies. Studies were identified by searching Medline (1990-2000). Articles were included if they presented original data on any patient-centered outcome (including costs or survival alone) for men screened and treated for prostate cancer. Review papers were excluded unless they were quantitative syntheses of the results of other primary studies. Economic and decision analytic papers were included if they presented information on outcomes of real or hypothetical patient cohorts. Each retrieved article was reviewed by one of the authors. Included papers were assigned one primary, mutually exclusive study design. For the “primary data” studies, information was abstracted on care setting, dates of the study, sample size, racial distribution, age, tumor differentiation, tumor stage, survival, statistical power, and types of outcomes measures (QOL-generic, QOL-cancer specific, QOL-prostate cancer specific, satisfaction, costs, utilities, and other). For the “economic and decision analytic” papers, information was abstracted on stage of disease, age range, outcomes, costs, and whether utilities were measured. Of the 198 included papers, there were 161 primary data papers categorized as follows: randomized trial (n = 28), nonrandomized trial (n = 13), prospective or retrospective cohort study (n = 55), case-control study (n = 0), cross-sectional study (n = 63), and meta-analysis (n = 2). The remaining 37 papers were economic and decision analytic papers. Among the 149 primary data papers that contained patient outcome data, there were 42 standard instruments used, accounting for 44% (179 of 410) of the measures overall. Almost three-quarters (71%) of papers included one, two, or three outcomes measures of all types (standard and nonstandard); three papers included seven outcomes measures, and one paper included nine. Over the 11-year time period, there was a nonstatistically significant trend toward more frequent use of standardized QOL instruments and a statistically significant trend toward increased reporting of race (P = .003). Standardization of measurement of health-related QOL, satisfaction with care, and economic cost effect among men screened and treated for prostate cancer is needed. A core set of similar questions, both generic and disease-specific, should ideally be asked in every study, although investigators should be encouraged to include additional question sets as appropriate to individual studies to get a more complete picture of how patients screened and treated for this condition are doing over time.

Prostate cancer outcomes research incorporates a broad spectrum of endpoints, from clinical or intermediate endpoints such as tumor shrinkage or patient compliance, to final endpoints such as survival or disease-free survival. Our article focuses on three types of final endpoints that are of growing interest to patients, providers, payers, and regulators—health-related quality of life (QOL), satisfaction with care, and economic cost effect. Such nontraditional endpoints hold the promise of improving our ability to understand the full burden of prostate cancer screening and treatment, although there remain methodologic challenges to overcome in measuring these nontraditional endpoints.

Backgroundon Prostate Cancer

Prostate cancer is a major public health concern for men, with 198 100 new prostate cancer cases and 31 500 prostate cancer deaths expected in the United States in 2001 (1). As a result of widespread prostate-specific antigen (PSA) screening, the lifetime risk of a prostate cancer diagnosis is now 16%, whereas the lifetime risk of a prostate cancer death is 3.4% (2), indicating that most men diagnosed with prostate cancer are not destined to die of their disease. In the “PSA era,” the difficulty in distinguishing indolent prostate cancers from those destined to cause morbidity or death has resulted in many men who are not destined to die of their prostate cancer being diagnosed and treated aggressively.

Early detection of prostate cancer is controversial because of the absence of randomized trials showing that screening and subsequent aggressive treatment with surgery or radiation reduces mortality, as well as because of the uncertain natural history of prostate cancer. Large, randomized trials of prostate cancer screening are underway in the United States (the Prostate, Lung, Colon, and Ovary Screening Trial) and Europe (the European Randomized Study of Screening for Prostate Cancer), and randomized trials of prostate cancer treatment are also underway in the United States (the Prostate Cancer Intervention versus Observation Trial). A recently published trial of radical prostatectomy versus expectant management from Scandinavia reported a small absolute reduction in prostate-cancer specific mortality with surgery after approximately 6 years of follow-up, but few of the study subjects were diagnosed through screening (3). Meanwhile, advocates of prostate cancer screening cite the recent declines in population-based prostate cancer mortality in the United States (4) as evidence of the effectiveness of prostate cancer screening. However, great caution must be exercised in drawing such conclusions from observational data because alternative explanations exist, as detailed in a three-part series in this journal (5-7).

Potential Roleand Importanceof Outcomes Researchfor This Cancer

The effect of widespread prostate cancer screening on the psychological health of participants has received only limited attention (8,9), and the net value of mass screening has been questioned (10). Because screening affects a large number of men relative to those who benefit, even a small adverse effect of screening on QOL could carry an effect on public health, outweighing any gain to be achieved by the screening. Outcomes research is needed to evaluate topics such as the potential benefits and harms of prostate cancer screening from the patient's perspective, the barriers to follow-up of suspicious screening tests, and the economic burden of screening.

Men diagnosed with either early or advanced prostate cancer face difficult treatment decisions, because there are various treatment options at each phase of disease, but the optimal treatment for any given stage of disease is unknown. For practical purposes, the phases of care for prostate cancer are broadly grouped as nonmetastatic and metastatic. With nonmetastatic disease there is a gradient of probabilities of extracapsular spread or nodal metastases (11), rather than a sharp distinction, in part because one would need surgical staging to be certain. For metastatic disease, this phase of care can be subclassified as hormone-sensitive or hormone-refractory prostate cancer.

For men with clinically localized prostate cancer, the choices range from aggressive, potentially curative therapy, such as radical prostatectomy, external beam radiation, and brachytherapy, which are all associated with clinically important side effects (12-18), to watchful waiting. Because of the good prognosis of the majority of clinically localized prostate cancers regardless of treatment choice, treatment outcomes, such as the likelihood of experiencing side effects from the various treatments, may be a critical factor for some men faced with a prostate cancer treatment decision (19). Most men treated have a >10-year life expectancy; thus, they have the potential to live many years with the outcomes (i.e., side effects) of therapy. For men with a rising PSA after presumably curative surgery or radiation therapy, the treatment of choice is often androgen deprivation; however, hormonal therapy has yet to be proven effective in this situation, and it is associated with clinically important side effects, as well. Meanwhile, data on the natural history of progression after PSA elevation following radical prostatectomy show that the median time to metastasis is 8 years, and the median time to death once metastases were documented is another 5 years—a relatively long interval between biochemical recurrence and clinical metastatic disease and death (20). Therefore, men weighing their choices of prostate cancer treatment should focus on the quality as well as the quantity of their lives (21).

In this report we review the last decade's published literature regarding the outcomes of prostate cancer screening and treatment to determine the “ state of the science” of outcomes measurement. The purpose of the review was to enumerate the types of outcome measurement used in the studies, rather than to determine the results of each study. Prostate cancer outcome measures can be applied in a variety of arenas (as noted in this Monograph's “ Overview,” p. 1-7); however, this article examines their use in descriptive and analytical studies. Thus, the focus of our article is on randomized clinical trials, observational studies, and economic and decision analytic investigations. It does not address the use of outcome measures in prostate cancer population surveillance studies or in clinical practice to improve patient-provider decision-making. The latter two arenas of application are discussed elsewhere in this Monograph.

Methods

Literature Search Strategy

The search strategy used to identify potentially relevant articles is provided below. The search strategy was designed to maximize the specificity of the search. The original search was run on September 1, 1999, and an update search was run on February 14, 2001. Search strategy (MH = MESH heading; MT = major topic):

Quality of life (MH), or

Survival analysis (MT), or

Health status indicators (MH), or

Activities of daily living (MH), or

Decision support techniques (MT), or

Decision making (MT), or

Choice behavior (MT), or

Medical futility (MT), or

Economics (MT), or

Costs and cost analysis (MT), or

Economic value of life (MT), or

Economics, hospital (MT), or

Economics, nursing (MT), or

Economics, pharmaceutical (MT), or

Health services research (MH), or

Delivery of health care (MT), or

Attitude to death (MT), or

Attitude to health (MT), or

Health services needs and demand (MT), or

Needs assessment (MT), or

Professional-patient relations (MT), or

Quality of health care (MT), or

Medical audit (MT), or

Nursing audit (MT), or

Outcome and process assessment (health care) (MT), or

Peer review, health care (MT), or

Professional review organizations (MT), or

Program evaluation (MT), or

Quality assurance, health care (MT), or

Guidelines (MT), or

Total quality management (MT), or

Quality indicators, health care (MT), or

Utilization review (MT),

And Prostatic Neoplasms,

And English language,

And Journal article,

And 1990-1999 (August); update was done for 8/99-2/01

And Abstract present

Each retrieved article was reviewed by one of the authors. Articles were included in the overview if they presented original data on any patient-centered outcome (including costs or survival alone) for men screened or treated for prostate cancer (review papers were excluded unless they were quantitative syntheses of the results of other primary studies). Reasons for exclusions were enumerated. Economic and decision analytic papers were included if they presented information on outcomes of real or hypothetical patient cohorts.

Summary Descriptions of Articles Identified, Retrieved, and Reviewed

The search strategy identified 397 potentially eligible papers (297 from the original search and 100 from the update search). All 397 papers were retrieved. After review of the retrieved papers, 198 were included in the overview and 199 were excluded. A table reporting summary information for each of the included papers is provided as Appendix 1. Reasons for exclusion for the remainder of the papers are provided in Table 1. Each paper was also identified as pertaining to prostate cancer screening or prostate cancer treatment. Overall, 54 of 397 papers were categorized as screening papers, and seven met the criteria for inclusion in this review. The most common reason for exclusion of a screening paper was because it reported solely on baseline knowledge or attitudes regarding prostate cancer screening, but not on QOL outcomes (n = 21). The second most common exclusion was for lack of an appropriate patient-centered outcome (i.e., only laboratory values or test results may have been presented; n = 16).

Appendix Table 1.

Evidence summary for 198 reviewed papers

First author (reference no.)   Year   Study design   Study setting   Sample size   Mean or median age, y   Race   Phase of care   Outcomes of interest   Outcome instruments used  
QOL = quality of life; CA = cancer; N/A = not abstracted.  
Abbott RR (31)  1998   Prospective or retrospective cohort study   Community-based   944   57   51% white, 44% black   Screening   Other type   Non-standard instrument  
Akakura K (101)  1999   Randomized trial   Multi-institution   100   68   Not provided   Non-metastatic disease   Survival QOL-CA specific   EORTC QLQ-C30  
Albertsen PC (102)  1997   Cross-sectional study   Multi-institution   113   72   79% white, 18% black, 1% other   Metastatic disease   QOL-generic   MOS 36 Item Health Survey  
         QOL-CA specific   EORTC QLQ-C30  
         QOL-prostate CA specific   1 non-standard instrument  
Albertsen PC (88)  1998   Cross-sectional study   Community-based   50   66   90% white, 10% black   Not provided   Utilities   Time trade-off  
          Health Utilities Index  
          1 non-standard instrument  
Allison RR (47)  1997   Prospective or retrospective cohort study   Single institution   34   70   Not provided   Non-metastatic disease   Survival only   
Arai Y (63)  1999   Prospective or retrospective cohort study   Single institution   60   68   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-generic Satisfaction   EORTC QLQ-PR25 4 non-standard instruments  
Arterbery VE (64)  1997   Prospective or retrospective cohort study   Single institution   51   Not provided   Not provided   Not provided   QOL-CA specific QOL-prostate CA specific QOL-generic Satisfaction   EORTC QLQ-C30 3 non-standard instruments  
Aus G (100)  1993   Prospective or retrospective cohort study   Single institution   485   67   Not provided   Screening   Other type   2 non-standard instruments  
Austenfeld MS (48)  1994   Meta-analysis   Other   .   Not provided   Not provided   Non-metastatic disease   Survival only   
Banerjee M (45)  2000   Prospective or retrospective cohort study   Single institution   485   Grouped frequencies provided   59% white, 41% black   Non-metastatic disease   Survival only   
Bates TS (103)  1998   Cross-sectional study   Single institution   87   65   Not provided   Not provided   QOL-prostate CA specific   ICS-Male questionnaire  
Beard CJ (104)  1997   Prospective or retrospective cohort study   Multi-institution   121   68   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific Other type   Profile of Mood States (POMS) 3 non-standard instruments  
Beck JR (79)  1994   Decision modeling   N/A   N/A   65   N/A   Non-metastatic disease   Survival Quality adjusted survival Estimated costs Utilities   Utilities by consensus panel  
Beemsterboer PM (87)  1999   Prospective or retrospective cohort study   Multi-institution   70   71   Not provided   Unable to determine from information provided   Survival Costs   Non-standard instrument  
Bennett CL (80)  1996   Cost-effectiveness study   N/A   N/A   70   N/A   Metastatic disease   Quality adjusted survival Estimated costs Utilities   Time trade-off (proxy)  
Bennett CL (98)  1997   Decision modeling   N/A   N/A   Not provided   N/A   Both   Quality adjusted survival Utilities   Time trade-off Time trade-off (proxy)  
Benoit RM (105)  1997   Cost-effectiveness study   N/A   N/A   50-69   N/A   Non-metastatic disease   Survival Estimated costs   
Benoit RM (66)  1998   Cost-identification study   N/A   N/A   Not provided   N/A   Non-metastatic disease   Costs   
Bergan RC (106)  1999   Non-Randomized trial   Single institution   34   64   Not provided   Metastatic disease   Survival QOL-CA specific   Functional Living Index-Cancer (FLIC)  
Bloomfield DJ (67)  1998   Cost-effectiveness study   N/A   N/A   Not provided   N/A   Metastatic disease   Quality adjusted survival Costs Estimated costs Utilities   Utilities by transformation of QOL scale  
Boccardo F (34)  1999   Randomized trial   Multi-institution   220   74   100% white   Both   Survival QOL-generic   WHO pain, performance, scores Non-standard instrument  
Borghede G (107)  1996   Cross-sectional study   Single institution   192   68   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific   EORTC QLQ-PR25 EORTC QLQ-C30  
Borghede G (108)  1997   Cross-sectional study   Community-based   1138   Not provided   Not provided   Not provided   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 EORTC QLQ-PR25  
Bouffioux C (109)  1994   Cross-sectional study   Single institution   102   Not provided   Not provided   Not provided   Survival QOL-prostate CA specific   Non-standard instrument  
Brandeis JM (42)  2000   Non-randomized trial   Single institution   256   65   69% white, 10% black, 10% Hispanic   Non-metastatic disease   Other type QOL-generic QOL-prostate CA specific QOL-CA specific   AUA Index (IPSS) MOS 36 Item Health Survey UCLA-PCI 2 non-standard instruments  
Braslis KG (110)  1995   Cross-sectional study   Single institution   51   63   80% white, 13% black, 8% Hispanic   Non-metastatic disease   QOL-CA specific QOL-generic QOL-prostate CA specific   Functional Living Index-Cancer (FLIC) Profile of Mood States (POMS) 4 non-standard instruments  
Caffo O (111)  1996   Cross-sectional study   Single institution   70   71   100% white   Non-metastatic disease   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 4 non-standard instruments  
Cantor SB (90)  1995   Decision modeling   N/A   N/A   50   N/A   Screening   Quality adjusted survival Utilities   Time trade-off (proxy)  
Carvalhal GF (112)  1999   Cross-sectional study   Community-based   1583   69   96% white, 4% black   Non-metastatic disease   Survival QOL-prostate CA specific   UCLA-PCI  
Cassileth BR (113)  1992   Non-randomized trial   Multi-institution   147   70   69% white   Metastatic disease   QOL-CA specific QOL-generic   Functional Living Index-Cancer (FLIC) Profile of Mood States (POMS)  
Chang P (81)  1990   Decision modeling   N/A   N/A   50   N/A   Screening   Estimated costs   
Chapman GB (23)  1998   Cross-sectional study   Multi-institution   59   70   25% white, 71% black, 2% Hispanic   Both   Utilities   Time trade-off  
Chapman GB (24)  1999   Cross-sectional study   Multi-institution   57   70   80% black   Both   Utilities   Time trade-off  
Chodak G (114)  1995   Randomized trial   Multi-institution   486   70   Not provided   Metastatic disease   Survival QOL-CA specific QOL-generic QOL-prostate CA specific   ECOG performance status 5 non-standard instruments  
Chon JK (68)  2000   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Cost   
Ciezki JP (69)  2000   Cost-identification study   N/A   N/A   Not provided   N/A   Non-metastatic disease   Cost   
Clark JA (115)  1997   Cross-sectional study   Multi-institution   199   71   53% white   Both   QOL-prostate CA specific   4 non-standard instruments  
Clark JA (116)  1999   Prospective or retrospective cohort study   Multi-institution   125   65   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey 4 non-standard instruments  
Coleman RE (117)  1997   Non-randomized trial   Single institution   17   Not provided   Not provided   Metastatic disease   Other type   Rotterdam Symptom Checklist Non-standard instrument  
Cowen ME (91)  1998   Decision modeling   N/A   N/A   55-75   N/A   Non-metastatic disease   Quality adjusted survival Utilities   Time trade-off (proxy)  
Crawford ED (118)  1997   Cross-sectional study   Other   1000   68   94% white, 4% black   Unable to determine from information provided   QOL-prostate CA specific QOL-generic   3 non-standard instruments  
Cresswell SM (119)  1995   Prospective or retrospective cohort study   Multi-institution   27   Not provided   Not provided   Metastatic disease   QOL-generic   WHO pain, performance, sub-scores 2 non-standard instruments  
Curran D (120)  1997   Randomized trial   Multi-institution   638   71   Not provided   Both   QOL-CA specific QOL-generic   EORTC QLQ-C30 Non-standard instrument WHO pain, performance, sub-scores  
da Silva FC (121)  1993   Randomized trial   Multi-institution   76   Not provided   Not provided   Metastatic disease   QOL-generic QOL-prostate CA specific QOL-CA specific   4 non-standard instruments  
da Silva FC (122)  1993   Randomized trial   Multi-institution   48   Not provided   Not provided   Metastatic disease   QOL-CA specific   EORTC QLQ-C30  
Dale W (25)  1999   Prospective or retrospective cohort study   Single institution   150   70   6% white, 88% black, 6% Hispanic   Non-metastatic disease   QOL-prostate CA specific   3 non-standard instruments  
Davison BJ (123)  1995   Cross-sectional study   Single institution   57   71   Not provided   Both   Other type   Non-standard instrument  
Davison BJ (124)  1997   Randomized trial   Single institution   60   68   Not provided   Not provided   Other type QOL-generic   2 non-standard instruments Speilberger state-trait anxiety inventory  
Dawson NA (35)  2000   Randomized trial   Multi-institution   149   72   80% white   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   Functional Living Index-Cancer (FLIC) EORTC QLQ-PR25 Wisconsin Brief Pain Inventory 2 non-standard instruments  
Demark-Wahnefried W (26)  1998   Cross-sectional study   Multi-institution   231   Not provided   49% white, 51% black   Both   Satisfaction   Non-standard instrument  
Dowling RA (49)  1991   Prospective or retrospective cohort study   Single institution   31   67   Not provided   Both   Survival only   
Duncan GG (125)  2000   Randomized trial   Single institution   217   71   Not provided   Non-metastatic disease   Survival Other type   Rotterdam Symptom Checklist  
Esper P (126)  1999   Cross-sectional study   Single institution   33   68   85% white, 12% black   Metastatic disease   QOL-CA specific QOL-prostate CA specific   Functional Assessment of Cancer Therapy (FACT) Functional Assessment of Cancer Therapy-Prostate (FACT-P)  
Essink-Bot ML (127)  1998   Prospective or retrospective cohort study   Multi-institution   626   63   Not provided   Not provided   QOL-generic   MOS 36 Item Health Survey EuroQol-5d Speilberger state-trait anxiety inventory  
Fields-Jones S (36)  1999   Non-randomized trial   Multi-institution   49   72   Not provided   Metastatic disease   Survival QOL-CA specific Other type   Karnofsky Performance Index Non-standard instrument  
Fitch MI (128)  1999   Cross-sectional study   Multi-institution   621   69   92% white   Not provided   QOL-prostate CA specific   3 non-standard instruments  
Fleming C (129)  1993   Decision modeling   N/A   N/A   60-75   N/A   Non-metastatic disease   Survival Quality adjusted survival   
Fossa SD (130)  1990   Prospective or retrospective cohort study   Multi-institution   72   Not provided   Not provided   Metastatic disease   QOL-generic QOL-prostate CA specific   6 non-standard instruments  
Fossa SD (131)  1994   Prospective or retrospective cohort study   Single institution   131   70   Not provided   Metastatic disease   QOL-generic QOL-prostate CA specific   6 non-standard instruments  
Fossa SD (132)  1997   Cross-sectional study   Multi-institution   379   68   Not provided   Not provided   QOL-CA specific QOL-generic Other type   EORTC QLQ-C30 Psychosocial Adjustment to Illness (PAIS) AUA Index (IPSS)  
Fossa SD (133)  2000   Randomized trial   Multi-institution   189   Grouped frequencies provided   Not provided   Metastatic disease   Survival QOL-CA specific   EORTC QLQ-C30  
Fowler FJ Jr (134)  1995   Cross-sectional study   Medicare   757   Not provided   Not provided   Not provided   QOL-prostate CA specific QOL-generic   4 non-standard instruments  
Fowler FJ Jr (135)  1996   Cross-sectional study   Medicare   621   Not provided   90% white   Not provided   QOL-generic QOL-prostate CA specific   4 non-standard instruments  
Franklin CI (136)  1996   Prospective or retrospective cohort study   Single institution   169   69   Not provided   Both   QOL-prostate CA specific   3 non-standard instruments  
Franklin CI (137)  1998   Cross-sectional study   Single institution   129   Not provided   Not provided   Not provided   Survival QOL-prostate CA specific   3 non-standard instruments  
Fransson P (138)  1996   Cross-sectional study   Single institution   181   71   Not provided   Both   Survival QOL-generic QOL-prostate CA specific   2 non-standard instruments  
Fransson P (139)  1999   Cross-sectional study   Single institution   83   73   Not provided   Non-metastatic disease   Survival QOL-generic QOL-prostate CA specific   4 non-standard instruments  
Frazer GH (140)  1998   Cross-sectional study   Single institution   47   72   Not provided   Not provided   QOL-generic   Non-standard instrument  
Frohmuller HG (141)  1995   Prospective or retrospective cohort study   Single institution   139   61   Not provided   Metastatic disease   Survival Other type   Non-standard instrument  
Gralnek D (142)  2000   Cross-sectional study   Single institution   129   Not provided   Not provided   Not provided   QOL-prostate CA specific Other type   UCLA-PCI 2 non-standard instruments  
Grover SA (143)  2000   Decision modeling   N/A   N/A   60-80   N/A   Both   Survival   
Hanks GE (50)  1994   Prospective or retrospective cohort study   Multi-institution   1396   67   Not provided   Non-metastatic disease   Survival only   
Heathcote PS (144)  1998   Cross-sectional study   Single institution   112   64   Not provided   Not provided   QOL-prostate CA specific QOL-generic   3 non-standard instruments  
Helgason AR (145)  1995   Cross-sectional study   Single institution   49   70   Not provided   Non-metastatic disease   QOL-prostate CA specific   Radiumhemmets Scale of Sexual Function  
Herr HW (146)  1993   Non-randomized trial   Single institution   35   65   Not provided   Metastatic disease   QOL-prostate CA specific QOL-generic QOL-CA specific   EORTC QLQ-PR25 Intrusion subscale of the Impact Event Scale QL Uniscale (Selby) Non-standard instrument  
Herr HW (147)  2000   Prospective or retrospective cohort study   Single institution   144   66   96% white, 3% black, 1% Hispanic   Non-metastatic disease   QOL-prostate CA specific QOL-generic   EORTC QLQ-PR25 Intrusion subscale of the Impact Event Scale QL Uniscale (Selby)  
Holmberg H (70)  1998   Cost-identification study   N/A   N/A   55-97   N/A   Both   Survival Costs Estimated Costs   
Holmberg H (71)  1998   Cost-effectiveness study   N/A   N/A   50-69   N/A   Both   Survival   
         Costs   
Huguenin PU (148)  1999   Prospective or retrospective cohort study   Single institution   167   Not provided   Not provided   Non-metastatic disease   Survival   EORTC QLQ-C30  
         QOL-CA specific   RTOG toxicity and morbidity scales  
Irani J (51)  1999   Prospective or retrospective cohort study   Multi-institution   161   64   Not provided   Unable to determine from information provided   Survival only   
Iversen P (58)  1998   Randomized trial   Multi-institution   480   73   90% white, 0.3% black, 1.6% Hispanic   Non-metastatic disease   Survival   9 non-standard instruments  
         QOL-generic   
Jager GJ (82)  2000   Cost-effectiveness study   N/A   N/A   65   N/A   Non-metastatic disease   Survival   
         Quality adjusted survival   
         Estimated cost   
Jakobsson L (149)  1997   Cross-sectional study   Single institution   11   74   Not provided   Not provided   QOL-CA specific   EORTC QLQ-C30  
         QOL-generic   Sense of Coherence scale (SOC)  
Jakobsson L (150)  1997   Cross-sectional study   Single institution   11   74   Not provided   Not provided   QOL-CA specific   EORTC QLQ-C30  
Jakobsson L (151)  2000   Cross-sectional study   Single institution   25   67   Not provided   Not provided   Other type   Non-standard instrument  
Janda M (43)  2000   Randomized trial   Single institution   41   67   Not provided   Both   QOL-generic   MOS 36 Item Health Survey  
         QOL-CA specific   EORTC QLQ-C30  
Johnstone PA (152)  2000   Prospective or retrospective cohort study   Single institution   46   67   Not provided   Unable to determine from information provided   Survival   MOS 36 Item Health Survey  
         QOL-generic   UCLA-PCI  
         QOL-prostate CA specific   
Joly F (153)  1998   Cross-sectional study   Single institution   71   68   Not provided   Non-metastatic disease   QOL-generic   Nottingham Health Profile  
         QOL-prostate CA specific   EORTC QLQ-PR25  
         QOL-CA specific   EORTC QLQ-C30  
Jonler M (56)  1994   Cross-sectional study   Single institution   98   Grouped frequencies provided   Not provided   Non-metastatic disease   Survival   7 non-standard instruments  
         QOL-prostate CA specific   
         QOL-generic   
         Satisfaction   
Jonler M (154)  1996   Prospective or retrospective cohort study   Single institution   24   Grouped frequencies provided   Not provided   Non-metastatic disease   QOL-prostate CA specific   6 non-standard instruments  
         QOL-generic   
Jonler M (57)  1998   Cross-sectional study   Single institution   52   69   Not provided   Non-metastatic disease   Satisfaction   7 non-standard instruments  
         QOL-prostate CA specific   
         QOL-generic   
Jungi WF (155)  1998   Prospective or retrospective cohort study   Multi-institution   28   69   Not provided   Metastatic disease   QOL-CA specific   EORTC QLQ-C30  
         QOL-generic   WHO pain, performance, sub-scores  
Kantoff PW (37)  1999   Randomized trial   Multi-institution   242   72   90% white   Metastatic disease   Survival   Functional Living Index-Cancer (FLIC)  
         QOL-CA specific   EORTC QLQ-PR25  
         QOL-prostate CA specific   3 non-standard instruments  
         QOL-generic   
Kattan MW (89)  1997   Decision modeling   N/A   N/A   60-75   N/A   Non-metastatic disease   Survival   Time trade-off  
         Quality adjusted survival   
         Utilities   
Kim SP (27)  1999   Cross-sectional study   Multi-institution   116   69   52% black   Not provided   QOL-CA specific   EORTC QLQ-C30  
         QOL-generic   Functional Assessment of Cancer Therapy (FACT)  
         Satisfaction   Karnofsky Performance Index  
         Other type   Attitude Towards Care Questionnaire  
         Utilities   Time trade-off  
          2 non-standard instruments  
Knight SJ (28)  1998   Cross-sectional study   Multi-institution   110   71   62% black   Metastatic disease   QOL-CA specific   EORTC QLQ-C30  
         QOL-prostate CA specific   Functional Assessment of Cancer Therapy-Prostate (FACT-P)  
         QOL-generic   Karnofsky Performance Index  
          Non-standard instrument  
Kobeissi BJ (83)  1998   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Estimated cost   
Kornblith AB (156)  1994   Cross-sectional study   Single institution   172   68   96% white, 3% black, 1% Hispanic   Not provided   QOL-prostate CA specific   EORTC QLQ-PR25  
         QOL-generic   Intrusion subscale of the Impact Event Scale  
          QL Uniscale (Selby)  
          Non-standard instrument  
Krahn MD (72)  1994   Decision modeling   N/A   N/A   50-70   N/A   Screening   Survival   Time trade-off (proxy)  
         Quality adjusted survival   
         Cost   
         Estimated cost   
         Utilities   
Krahn MD (73)  1999   Cost-identification study   N/A   N/A   40-74   N/A   Both   Cost   
         Other   
Kramolowsky EV (84)  1995   Cost-identification study   N/A   N/A   Not provided   N/A   Not provided   Estimated cost   
         Other   
Kreis W (157)  1990   Prospective or retrospective cohort study   Multi-institution   118   69   Not provided   Metastatic disease   QOL-CA specific   ECOG performance status  
Krongrad A (158)  1997   Prospective or retrospective cohort study   Single institution   29   68   Not provided   Not provided   QOL-generic   Rand Mental Health Index  
         QOL-CA specific   Functional Living Index-Cancer (FLIC)  
Krongrad A (159)  1998   Cross-sectional study   HMO or managed care network   271   73   62% white   Not provided   QOL-generic   MOS 36 Item Health Survey UCLA-PCI  
         QOL-prostate CA specific   
Krupski T (160)  2000   Cross-sectional study   Single institution   138   Not provided   88% white, 11% black   Non-metastatic disease   Other type   AUA Index (IPSS)  
         QOL-CA specific   Functional Assessment of Cancer Therapy (FACT)  
         QOL-generic   2 non-standard instruments  
         QOL-prostate CA specific   
Kurtz ME (161)  1997   Cross-sectional study   Multi-institution   188   Not provided   Not provided   Not provided   QOL-generic   MOS 36 Item Health Survey  
Larson G (65)  2000   Cross-sectional study   Single institution   88   67   Not provided   Not provided   Survival Satisfaction QOL-prostate CA specific   2 non-standard instruments  
Leandri P (162)  1992   Prospective or retrospective cohort study   Single institution   620   68   Not provided   Non-metastatic disease   Survival QOL-prostate CA specific   2 non-standard instruments  
Lee WR (163)  1999   Prospective or retrospective cohort study   Single institution   46   68   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific Other type   Functional Assessment of Cancer Therapy-Prostate (FACT-P) Functional Assessment of Cancer Therapy (FACT) AUA Index (IPSS)  
Lee WR (164)  2000   Prospective or retrospective cohort study   Single institution   74   68   Not provided   Non-metastatic disease   Other type   AUA Index (IPSS)  
Licht MR (85)  1994   Cost-identification study   Single institution   272   62   Not provided   Non-metastatic disease   Estimated cost   
Lilleby W (165)  1999   Cross-sectional study   Single institution   262   65   Not provided   Not provided   QOL-CA specific Other type QOL-generic   EORTC QLQ-C30 AUA Index (IPSS) Non-standard instrument  
Lim AJ (59)  1995   Cross-sectional study   Single institution   196   69   77% white, 3% black, 10% Hispanic   Non-metastatic disease   QOL-CA specific QOL-generic QOL-prostate CA specific Satisfaction   Functional Living Index-Cancer (FLIC) Profile of Mood States (POMS) 2 non-standard instruments  
Litwin MS (166)  1995   Cross-sectional study   Single institution   214   73   60% white, 25% black, 10% Hispanic   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey Functional Assessment of Cancer Therapy (FACT) Cancer Rehabilitation Evaluation System UCLA-PCI  
Litwin MS (167)  1998   Prospective or retrospective cohort study   Single institution   63   72   79% white, 11% black, 6% Hispanic   Metastatic disease   Survival QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI  
Litwin MS (168)  1998   Cross-sectional study   Multi-institution   2252   71   Not provided   Not provided   QOL-generic QOL-prostate CA specific QOL-CA specific   MOS 36 Item Health Survey UCLA-PCI Karnofsky Performance Index Non-standard instrument  
Litwin MS (44)  1999   Prospective or retrospective cohort study   Multi-institution   438   64   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI  
Lubeck DP (169)  1997   Cross-sectional study   Multi-institution   2382   68   89.4% white, 6.7% black, 2.1% Hispanic   Both   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI 4 non-standard instruments  
Lubeck DP (170)  1999   Prospective or retrospective cohort study   Multi-institution   692   67   81.5% white, 10.4% black, 1.9% Hispanic   Both   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI 4 non-standard instruments  
Lucas MD (171)  1995   Prospective or retrospective cohort study   Single institution   15   76   Not provided   Metastatic disease    Quality of Life Index (Spitzer)  
Malmberg I (74)  1997   Cost-effectiveness study   N/A   N/A   Not provided   N/A   Metastatic disease   Survival Costs Estimated costs   
Mantz CA (172)  1999   Prospective or retrospective cohort study   Single institution   287   69   Not provided   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Maxon HR 3d (173)  1990   Non-randomized trial   Single institution   20   65   Not provided   Metastatic disease   QOL-prostate CA specific QOL-CA specific   Karnofsky Performance Index 3 non-standard instruments  
Mazur DJ (92)  1995   Decision modeling   N/A   N/A   35-84   N/A   Non-metastatic disease   Survival Utilities   Time trade-off (proxy)  
Mazur DJ (93)  1996   Decision modeling   N/A   N/A   30-85   N/A   Non-metastatic disease   Survival Utilities   Time trade-off (proxy)  
McCammon KA (60)  1999   Cross-sectional study   Single institution   460   Group information only   Not provided   Not provided   QOL-prostate CA specific Satisfaction   4 non-standard instruments  
Meng MV (174)  2000   Decision modeling   N/A   N/A   Not provided   N/A   Both   Other   
Meyer F (46)  1999   Prospective or retrospective cohort study   Community-based   384   67   Not provided   Both   Survival only   
Michalski JM (175)  2000   Non-randomized trial   Multi-institution   288   Not provided   Not provided   Non-metastatic disease   QOL-CA specific   RTOG toxicity and morbidity scales  
Moinpour CM (176)  1998   Randomized trial   Multi-institution   739   70   74% white, 25% black   Metastatic disease   QOL-CA specific QOL-generic   SWOG QOL questionnaire MOS 36 Item Health Survey  
Mold JW (94)  1992   Decision modeling   N/A   N/A   65   N/A   Screening   Survival Quality adjusted survival Utilities   Kaplan-Anderson Quality of Well Being Scale (proxy)  
Moore KN (177)  1999   Cross-sectional study   Multi-institution   63   67   Not provided   Not provided   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 Non-standard instrument  
Moore MJ (178)  1994   Non-randomized trial   Multi-institution   27   69   Not provided   Both   Survival QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 EORTC QLQ-PR25  
Mushinski M (75)  1996   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Costs Other   
Nicol DL (76)  1993   Cost-identification study   N/A   N/A   Not provided   N/A   Metastatic disease   Costs Other   
Oosterlinck W (179)  1996   Prospective or retrospective cohort study   Multi-institution   905   Not provided   Not provided   Both   QOL-prostate CA specific   Non-standard instrument  
Oosterlinck W (52)  1997   Prospective or retrospective cohort study   Multi-institution   546   74   Not provided   Non-metastatic disease   Survival only   
Osoba D (180)  1999   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 Prostate Cancer Specific QOL Instrument QOL module (QLM-P14, trial specific)  
Pannek J (181)  1997   Prospective or retrospective cohort study   Single institution   23   64   Not provided   Non-metastatic disease   Survival QOL-generic QOL-CA specific   2 non-standard instruments EMPK scales  
Patel BR (32)  1997   Non-randomized trial   Single institution   6   Not provided   Not provided   Metastatic disease   QOL-generic   Non-standard instrument  
Pedersen KV (182)  1993   Prospective or retrospective cohort study   Single institution   131   64   Not provided   Not provided   QOL-generic QOL-prostate CA specific   4 non-standard instruments  
Peetermans C (183)  1994   Non-randomized trial   Multi-institution   164   73   Not provided   Both   Survival QOL-generic   Non-standard instrument  
Perez MA (184)  1997   Cross-sectional study   Single institution   294   67   91% white   Not provided   QOL-prostate CA specific Other type   2 non-standard instruments  
Perrotte P (61)  1999   Prospective or retrospective cohort study   Single institution   112   68   92% white, 3% black   Non-metastatic disease   QOL-prostate CA specific Satisfaction   UCLA-PCI Non-standard instrument  
Pickles T (185)  1999   Randomized trial   Multi-institution   217   71   Not provided   Non-metastatic disease   Survival QOL-CA specific QOL-prostate CA specific   RTOG toxicity and morbidity scales 3 non-standard instruments  
Popov I (186)  1997   Prospective or retrospective cohort study   Single institution   15   65   Not provided   Metastatic disease   Other type   Rotterdam Symptom Checklist  
Porter AT (187)  1993   Randomized trial   Multi-institution   124   71   Not provided   Metastatic disease   Survival QOL-prostate CA specific QOL-generic   2 non-standard instruments  
Porterfield HA (188)  1997   Cross-sectional study   Community-based   1000   Grouped frequencies provided   94% white, 4% black   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Potosky AL (53)  1999   Prospective or retrospective cohort study   Medicare   21 741   Not provided   88% white, 7% black, 5% other   Both   Survival only   
Pousette A (54)  1999   Prospective or retrospective cohort study   Single institution   231   Not provided   Not provided   Not provided   Survival only   
Presti JC Jr (189)  1992   Randomized trial   Multi-institution   28   68   Not provided   Metastatic disease   QOL-generic QOL-CA specific   Karnofsky Performance Index Non-standard instrument  
Raghavan D (190)  1996   Prospective or retrospective cohort study   Multi-institution   50   67   Not provided   Metastatic disease   Survival QOL-prostate CA specific QOL-CA specific   ECOG performance status 2 non-standard instruments  
Rana A (55)  1993   Prospective or retrospective cohort study   Single institution   107   74   Not provided   Non-metastatic disease   Survival only   
Reddy SM (191)  1997   Cross-sectional study   Single institution   75   Not provided   Not provided   Non-metastatic disease   QOL-prostate CA specific   4 non-standard instruments  
Roach M 3rd (192)  1996   Cross-sectional study   Single institution   60   72   Not provided   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Robinson JW (193)  1999   Prospective or retrospective cohort study   Single institution   69   66   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific   Functional Assessment of Cancer Therapy-Prostate (FACT-P) Functional Assessment of Cancer Therapy (FACT)  
Rosendahl I (194)  1999   Randomized trial   Multi-institution   297   Not provided   Not provided   Metastatic disease   Survival Other type   Q-twist  
Rossetti SR (62)  1996   Prospective or retrospective cohort study   Single institution   161   Not provided   Not provided   Not provided   Survival Satisfaction   Non-standard instrument  
Roth AJ (195)  1998   Cross-sectional study   Single institution   121   71   88% white   Both   QOL-generic QOL-CA specific   Hospital anxiety and depression scale (HADS) Non-standard instrument  
Sall M (196)  1997   Prospective or retrospective cohort study   Single institution   24   61   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-generic   Wisconsin Brief Pain Inventory 2 non-standard instruments  
Santis WF (197)  2000   Prospective or retrospective cohort study   Single institution   100   62   Not provided   Not provided   QOL-prostate CA specific   Non-standard instrument  
Sarosdy MF (198)  1999   Prospective or retrospective cohort study   Multi-institution   59   70   56% white, 29% black, 13% Hispanic   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Schag CA (199)  1994   Cross-sectional study   Multi-institution   104   70   92% white, 4% black, 4% Hispanic   Non-metastatic disease   QOL-CA specific   Cancer Rehabilitation Evaluation System QOL Linear analogue self assessment (QOL-LASA)  
Schroder FH (200)  2000   Randomized trial   Multi-institution   294   71   Not provided   Not provided   QOL-prostate CA specific   Non-standard instrument  
Seidenfeld J (201)  2000   Meta-analysis   Multi-institution   6600   Not provided   Not provided   Unable to determine from information provided   Survival QOL-prostate CA specific QOL-CA specific   Non-standard instrument Functional Living Index-Cancer (FLIC)  
Sharp LK (29)  1999   Prospective or retrospective cohort study   Multi-institution   110   72   35% white, 62% black   Metastatic disease   QOL-CA specific QOL-generic   EORTC QLQ-C30 Functional Assessment of Cancer Therapy (FACT) Quality of Life Index (Spitzer) Karnofsky Performance Index  
Shrader-Bogen CL (202)  1997   Cross-sectional study   Single institution   274   71   95% white, 1% Hispanic   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific   Prostate Cancer Treatment Outcome Questionnaire Functional Assessment of Cancer Therapy (FACT)  
Shukla SK (203)  1997   Non-randomized trial   Other   31   65   Not provided   Metastatic disease   Other type   Non-standard instrument  
Singer PA (95)  1991   Decision modeling   N/A   N/A   45-70   N/A   Non-metastatic disease   Survival Utilities   Trade-off (proxy, survival vs. potency)  
Small EJ (38)  2000   Randomized trial   Multi-institution   460   68   91% white, 9% black, 1% other   Metastatic disease   Survival QOL-CA specific Other type QOL-generic   Functional Assessment of Cancer Therapy (FACT) Revised Rand Functional Limitations Scale (RRFLS) Non-standard instrument  
Smathers S (204)  2000   Cross-sectional study   Single institution   58   Not provided   Not provided   Not provided   Other type Satisfaction   3 non-standard instruments  
Smith DC (39)  1999   Prospective or retrospective cohort study   Single institution   37   64   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific   Functional Assessment of Cancer Therapy (FACT) Functional Assessment of Cancer Therapy-Prostate (FACT-P) National Cancer Institute Common Toxicity Criteria  
Smith DS (205)  2000   Cross-sectional study   Single institution   1651   70   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI Non-standard instrument  
Smith MF (206)  1990   Non-randomized trial   Single institution   24   70   Not provided   Metastatic disease   Survival QOL-generic   3 non-standard instruments  
Soloway MS (207)  1996   Randomized trial   Multi-institution   813   70   72% white, 23% black   Metastatic disease   Survival QOL-generic   Non-standard instrument  
Souchek J (40)  2000   Prospective or retrospective cohort study   Multi-institution   120   72   68.3% white, 27.5% black   Metastatic disease   Utilities   Time trade-off Standard Gamble 1 non-standard instrument  
Stier DM (208)  1999   Cross-sectional study   Multi-institution   1638   68   97% white   Not provided   QOL-generic QOL-CA specific   MOS 36 Item Health Survey TIBI- total illness burden index TIBI-P total illness burden index-prostate  
Stockler MR (209)  1998   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   EORTC QLQ-C30 Prostate Cancer Specific QOL Instrument QOL module (QLM-P14, trial specific) Present Pain Intensity (PPI)  
Stockler MR (210)  1999   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   EORTC QLQ-C30 Prostate Cancer Specific QOL Instrument QOL module (QLM-P14, trial specific) Present Pain Intensity (PPI)  
Stone P (211)  2000   Cross-sectional study   Single institution   62   69   89% white, 1% black   Both   QOL-CA specific QOL-prostate CA specific Other type QOL-generic   EORTC QLQ-C30 Functional Assessment of Cancer Therapy-Prostate (FACT-P) Fatigue Severity Scale (FSS) Bidimensional Fatigue Scale (BFS) Hospital anxiety and depression scale (HADS)  
Tannock IF (212)  1996   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   EORTC QLQ-C30 EORTC QLQ-PR25 Prostate Cancer Specific QOL Instrument Present Pain Intensity (PPI) Non-standard instrument  
Taplin SH (86)  1995   Cost-identification study   N/A   N/A   35-80   N/A   Both   Estimated cost   
Tefilli MV (213)  1998   Cross-sectional study   Single institution   68   66   Not provided   Non-metastatic disease   Survival QOL-prostate CA specific QOL-CA specific   Functional Assessment of Cancer Therapy-Prostate (FACT-P) Functional Assessment of Cancer Therapy (FACT)  
Tyrrell CJ (214)  1998   Randomized trial   Multi-institution   1288   72   98% white, 1% black   Metastatic disease   Survival QOL-prostate CA specific   Non-standard instrument  
Ullman M (77)  1996   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Costs other   
van Andel G (215)  1997   Cross-sectional study   Multi-institution   55   Not provided   Not provided   Metastatic disease   QOL-CA specific Other type QOL-generic   EORTC QLQ-C30 AUA Index (IPSS) QL Uniscale (Selby) Non-standard instrument  
van Andel G (41)  2000   Randomized trial   Multi-institution   26   68   Not provided   Metastatic disease   Survival Other type QOL-CA specific   Rotterdam Symptom Checklist Non-standard instrument  
Volk RJ (96)  1997   Decision modeling   N/A   N/A   50   N/A   Screening   Quality adjusted survival Utilities   Time trade-off (proxy)  
Wagner TT (216)  1999   Cost-identification study   N/A   N/A   Not provided   N/A   Non-metastatic disease   Hospital Charges   
Walsh PC (217)  1994   Prospective or retrospective cohort study   Single institution   955   59   Not provided   Non-metastatic disease   Survival QOL-prostate CA specific   2 non-standard instruments  
Wang H (30)  2000   Cross-sectional study   Single institution   72   70   16.7% white, 80.6% black, 2.8% Hispanic   Unable to determine from information provided   QOL-generic QOL-prostate CA specific   3 non-standard instruments  
Wei JT (218)  2000   Prospective or retrospective cohort study   Single institution   145   62   Not provided   Non-metastatic disease   Other type   Non-standard instrument  
Wilt TJ (219)  1997   Randomized trial   Multi-institution   238   67   68% white, 24% black   Non-metastatic disease   QOL-generic   Non-standard instrument  
Wolf JS Jr (78)  1995   Cost-effectiveness study   N/A   N/A   Not provided   N/A   Both   Costs Estimated costs Utilities   Utility values calculated (proxy)  
Yao SL (33)  1999   Cross-sectional study   Community-based   101 604   69   89.5% white, 5.1% black, 5.4% Hispanic   Not provided   Survival only   
Yarbro CH (220)  1998   Cross-sectional study   Single institution   121   72   97% white   Unable to determine from information provided   QOL-prostate CA specific QOL-generic   UCLA-PCI Quality of Life Index (Spitzer)  
Yoshimura N (99)  1998   Decision modeling   N/A   N/A   60   N/A   Non-metastatic disease   Survival Quality adjusted survival Utilities   Utilities estimated from literature  
Zwetsloot-Schonk JH (97)  1993   Decision modeling   N/A   N/A   62   N/A   Both   Survival Quality adjusted survival Utilities   Utility values calculated (proxy)  
First author (reference no.)   Year   Study design   Study setting   Sample size   Mean or median age, y   Race   Phase of care   Outcomes of interest   Outcome instruments used  
QOL = quality of life; CA = cancer; N/A = not abstracted.  
Abbott RR (31)  1998   Prospective or retrospective cohort study   Community-based   944   57   51% white, 44% black   Screening   Other type   Non-standard instrument  
Akakura K (101)  1999   Randomized trial   Multi-institution   100   68   Not provided   Non-metastatic disease   Survival QOL-CA specific   EORTC QLQ-C30  
Albertsen PC (102)  1997   Cross-sectional study   Multi-institution   113   72   79% white, 18% black, 1% other   Metastatic disease   QOL-generic   MOS 36 Item Health Survey  
         QOL-CA specific   EORTC QLQ-C30  
         QOL-prostate CA specific   1 non-standard instrument  
Albertsen PC (88)  1998   Cross-sectional study   Community-based   50   66   90% white, 10% black   Not provided   Utilities   Time trade-off  
          Health Utilities Index  
          1 non-standard instrument  
Allison RR (47)  1997   Prospective or retrospective cohort study   Single institution   34   70   Not provided   Non-metastatic disease   Survival only   
Arai Y (63)  1999   Prospective or retrospective cohort study   Single institution   60   68   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-generic Satisfaction   EORTC QLQ-PR25 4 non-standard instruments  
Arterbery VE (64)  1997   Prospective or retrospective cohort study   Single institution   51   Not provided   Not provided   Not provided   QOL-CA specific QOL-prostate CA specific QOL-generic Satisfaction   EORTC QLQ-C30 3 non-standard instruments  
Aus G (100)  1993   Prospective or retrospective cohort study   Single institution   485   67   Not provided   Screening   Other type   2 non-standard instruments  
Austenfeld MS (48)  1994   Meta-analysis   Other   .   Not provided   Not provided   Non-metastatic disease   Survival only   
Banerjee M (45)  2000   Prospective or retrospective cohort study   Single institution   485   Grouped frequencies provided   59% white, 41% black   Non-metastatic disease   Survival only   
Bates TS (103)  1998   Cross-sectional study   Single institution   87   65   Not provided   Not provided   QOL-prostate CA specific   ICS-Male questionnaire  
Beard CJ (104)  1997   Prospective or retrospective cohort study   Multi-institution   121   68   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific Other type   Profile of Mood States (POMS) 3 non-standard instruments  
Beck JR (79)  1994   Decision modeling   N/A   N/A   65   N/A   Non-metastatic disease   Survival Quality adjusted survival Estimated costs Utilities   Utilities by consensus panel  
Beemsterboer PM (87)  1999   Prospective or retrospective cohort study   Multi-institution   70   71   Not provided   Unable to determine from information provided   Survival Costs   Non-standard instrument  
Bennett CL (80)  1996   Cost-effectiveness study   N/A   N/A   70   N/A   Metastatic disease   Quality adjusted survival Estimated costs Utilities   Time trade-off (proxy)  
Bennett CL (98)  1997   Decision modeling   N/A   N/A   Not provided   N/A   Both   Quality adjusted survival Utilities   Time trade-off Time trade-off (proxy)  
Benoit RM (105)  1997   Cost-effectiveness study   N/A   N/A   50-69   N/A   Non-metastatic disease   Survival Estimated costs   
Benoit RM (66)  1998   Cost-identification study   N/A   N/A   Not provided   N/A   Non-metastatic disease   Costs   
Bergan RC (106)  1999   Non-Randomized trial   Single institution   34   64   Not provided   Metastatic disease   Survival QOL-CA specific   Functional Living Index-Cancer (FLIC)  
Bloomfield DJ (67)  1998   Cost-effectiveness study   N/A   N/A   Not provided   N/A   Metastatic disease   Quality adjusted survival Costs Estimated costs Utilities   Utilities by transformation of QOL scale  
Boccardo F (34)  1999   Randomized trial   Multi-institution   220   74   100% white   Both   Survival QOL-generic   WHO pain, performance, scores Non-standard instrument  
Borghede G (107)  1996   Cross-sectional study   Single institution   192   68   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific   EORTC QLQ-PR25 EORTC QLQ-C30  
Borghede G (108)  1997   Cross-sectional study   Community-based   1138   Not provided   Not provided   Not provided   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 EORTC QLQ-PR25  
Bouffioux C (109)  1994   Cross-sectional study   Single institution   102   Not provided   Not provided   Not provided   Survival QOL-prostate CA specific   Non-standard instrument  
Brandeis JM (42)  2000   Non-randomized trial   Single institution   256   65   69% white, 10% black, 10% Hispanic   Non-metastatic disease   Other type QOL-generic QOL-prostate CA specific QOL-CA specific   AUA Index (IPSS) MOS 36 Item Health Survey UCLA-PCI 2 non-standard instruments  
Braslis KG (110)  1995   Cross-sectional study   Single institution   51   63   80% white, 13% black, 8% Hispanic   Non-metastatic disease   QOL-CA specific QOL-generic QOL-prostate CA specific   Functional Living Index-Cancer (FLIC) Profile of Mood States (POMS) 4 non-standard instruments  
Caffo O (111)  1996   Cross-sectional study   Single institution   70   71   100% white   Non-metastatic disease   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 4 non-standard instruments  
Cantor SB (90)  1995   Decision modeling   N/A   N/A   50   N/A   Screening   Quality adjusted survival Utilities   Time trade-off (proxy)  
Carvalhal GF (112)  1999   Cross-sectional study   Community-based   1583   69   96% white, 4% black   Non-metastatic disease   Survival QOL-prostate CA specific   UCLA-PCI  
Cassileth BR (113)  1992   Non-randomized trial   Multi-institution   147   70   69% white   Metastatic disease   QOL-CA specific QOL-generic   Functional Living Index-Cancer (FLIC) Profile of Mood States (POMS)  
Chang P (81)  1990   Decision modeling   N/A   N/A   50   N/A   Screening   Estimated costs   
Chapman GB (23)  1998   Cross-sectional study   Multi-institution   59   70   25% white, 71% black, 2% Hispanic   Both   Utilities   Time trade-off  
Chapman GB (24)  1999   Cross-sectional study   Multi-institution   57   70   80% black   Both   Utilities   Time trade-off  
Chodak G (114)  1995   Randomized trial   Multi-institution   486   70   Not provided   Metastatic disease   Survival QOL-CA specific QOL-generic QOL-prostate CA specific   ECOG performance status 5 non-standard instruments  
Chon JK (68)  2000   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Cost   
Ciezki JP (69)  2000   Cost-identification study   N/A   N/A   Not provided   N/A   Non-metastatic disease   Cost   
Clark JA (115)  1997   Cross-sectional study   Multi-institution   199   71   53% white   Both   QOL-prostate CA specific   4 non-standard instruments  
Clark JA (116)  1999   Prospective or retrospective cohort study   Multi-institution   125   65   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey 4 non-standard instruments  
Coleman RE (117)  1997   Non-randomized trial   Single institution   17   Not provided   Not provided   Metastatic disease   Other type   Rotterdam Symptom Checklist Non-standard instrument  
Cowen ME (91)  1998   Decision modeling   N/A   N/A   55-75   N/A   Non-metastatic disease   Quality adjusted survival Utilities   Time trade-off (proxy)  
Crawford ED (118)  1997   Cross-sectional study   Other   1000   68   94% white, 4% black   Unable to determine from information provided   QOL-prostate CA specific QOL-generic   3 non-standard instruments  
Cresswell SM (119)  1995   Prospective or retrospective cohort study   Multi-institution   27   Not provided   Not provided   Metastatic disease   QOL-generic   WHO pain, performance, sub-scores 2 non-standard instruments  
Curran D (120)  1997   Randomized trial   Multi-institution   638   71   Not provided   Both   QOL-CA specific QOL-generic   EORTC QLQ-C30 Non-standard instrument WHO pain, performance, sub-scores  
da Silva FC (121)  1993   Randomized trial   Multi-institution   76   Not provided   Not provided   Metastatic disease   QOL-generic QOL-prostate CA specific QOL-CA specific   4 non-standard instruments  
da Silva FC (122)  1993   Randomized trial   Multi-institution   48   Not provided   Not provided   Metastatic disease   QOL-CA specific   EORTC QLQ-C30  
Dale W (25)  1999   Prospective or retrospective cohort study   Single institution   150   70   6% white, 88% black, 6% Hispanic   Non-metastatic disease   QOL-prostate CA specific   3 non-standard instruments  
Davison BJ (123)  1995   Cross-sectional study   Single institution   57   71   Not provided   Both   Other type   Non-standard instrument  
Davison BJ (124)  1997   Randomized trial   Single institution   60   68   Not provided   Not provided   Other type QOL-generic   2 non-standard instruments Speilberger state-trait anxiety inventory  
Dawson NA (35)  2000   Randomized trial   Multi-institution   149   72   80% white   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   Functional Living Index-Cancer (FLIC) EORTC QLQ-PR25 Wisconsin Brief Pain Inventory 2 non-standard instruments  
Demark-Wahnefried W (26)  1998   Cross-sectional study   Multi-institution   231   Not provided   49% white, 51% black   Both   Satisfaction   Non-standard instrument  
Dowling RA (49)  1991   Prospective or retrospective cohort study   Single institution   31   67   Not provided   Both   Survival only   
Duncan GG (125)  2000   Randomized trial   Single institution   217   71   Not provided   Non-metastatic disease   Survival Other type   Rotterdam Symptom Checklist  
Esper P (126)  1999   Cross-sectional study   Single institution   33   68   85% white, 12% black   Metastatic disease   QOL-CA specific QOL-prostate CA specific   Functional Assessment of Cancer Therapy (FACT) Functional Assessment of Cancer Therapy-Prostate (FACT-P)  
Essink-Bot ML (127)  1998   Prospective or retrospective cohort study   Multi-institution   626   63   Not provided   Not provided   QOL-generic   MOS 36 Item Health Survey EuroQol-5d Speilberger state-trait anxiety inventory  
Fields-Jones S (36)  1999   Non-randomized trial   Multi-institution   49   72   Not provided   Metastatic disease   Survival QOL-CA specific Other type   Karnofsky Performance Index Non-standard instrument  
Fitch MI (128)  1999   Cross-sectional study   Multi-institution   621   69   92% white   Not provided   QOL-prostate CA specific   3 non-standard instruments  
Fleming C (129)  1993   Decision modeling   N/A   N/A   60-75   N/A   Non-metastatic disease   Survival Quality adjusted survival   
Fossa SD (130)  1990   Prospective or retrospective cohort study   Multi-institution   72   Not provided   Not provided   Metastatic disease   QOL-generic QOL-prostate CA specific   6 non-standard instruments  
Fossa SD (131)  1994   Prospective or retrospective cohort study   Single institution   131   70   Not provided   Metastatic disease   QOL-generic QOL-prostate CA specific   6 non-standard instruments  
Fossa SD (132)  1997   Cross-sectional study   Multi-institution   379   68   Not provided   Not provided   QOL-CA specific QOL-generic Other type   EORTC QLQ-C30 Psychosocial Adjustment to Illness (PAIS) AUA Index (IPSS)  
Fossa SD (133)  2000   Randomized trial   Multi-institution   189   Grouped frequencies provided   Not provided   Metastatic disease   Survival QOL-CA specific   EORTC QLQ-C30  
Fowler FJ Jr (134)  1995   Cross-sectional study   Medicare   757   Not provided   Not provided   Not provided   QOL-prostate CA specific QOL-generic   4 non-standard instruments  
Fowler FJ Jr (135)  1996   Cross-sectional study   Medicare   621   Not provided   90% white   Not provided   QOL-generic QOL-prostate CA specific   4 non-standard instruments  
Franklin CI (136)  1996   Prospective or retrospective cohort study   Single institution   169   69   Not provided   Both   QOL-prostate CA specific   3 non-standard instruments  
Franklin CI (137)  1998   Cross-sectional study   Single institution   129   Not provided   Not provided   Not provided   Survival QOL-prostate CA specific   3 non-standard instruments  
Fransson P (138)  1996   Cross-sectional study   Single institution   181   71   Not provided   Both   Survival QOL-generic QOL-prostate CA specific   2 non-standard instruments  
Fransson P (139)  1999   Cross-sectional study   Single institution   83   73   Not provided   Non-metastatic disease   Survival QOL-generic QOL-prostate CA specific   4 non-standard instruments  
Frazer GH (140)  1998   Cross-sectional study   Single institution   47   72   Not provided   Not provided   QOL-generic   Non-standard instrument  
Frohmuller HG (141)  1995   Prospective or retrospective cohort study   Single institution   139   61   Not provided   Metastatic disease   Survival Other type   Non-standard instrument  
Gralnek D (142)  2000   Cross-sectional study   Single institution   129   Not provided   Not provided   Not provided   QOL-prostate CA specific Other type   UCLA-PCI 2 non-standard instruments  
Grover SA (143)  2000   Decision modeling   N/A   N/A   60-80   N/A   Both   Survival   
Hanks GE (50)  1994   Prospective or retrospective cohort study   Multi-institution   1396   67   Not provided   Non-metastatic disease   Survival only   
Heathcote PS (144)  1998   Cross-sectional study   Single institution   112   64   Not provided   Not provided   QOL-prostate CA specific QOL-generic   3 non-standard instruments  
Helgason AR (145)  1995   Cross-sectional study   Single institution   49   70   Not provided   Non-metastatic disease   QOL-prostate CA specific   Radiumhemmets Scale of Sexual Function  
Herr HW (146)  1993   Non-randomized trial   Single institution   35   65   Not provided   Metastatic disease   QOL-prostate CA specific QOL-generic QOL-CA specific   EORTC QLQ-PR25 Intrusion subscale of the Impact Event Scale QL Uniscale (Selby) Non-standard instrument  
Herr HW (147)  2000   Prospective or retrospective cohort study   Single institution   144   66   96% white, 3% black, 1% Hispanic   Non-metastatic disease   QOL-prostate CA specific QOL-generic   EORTC QLQ-PR25 Intrusion subscale of the Impact Event Scale QL Uniscale (Selby)  
Holmberg H (70)  1998   Cost-identification study   N/A   N/A   55-97   N/A   Both   Survival Costs Estimated Costs   
Holmberg H (71)  1998   Cost-effectiveness study   N/A   N/A   50-69   N/A   Both   Survival   
         Costs   
Huguenin PU (148)  1999   Prospective or retrospective cohort study   Single institution   167   Not provided   Not provided   Non-metastatic disease   Survival   EORTC QLQ-C30  
         QOL-CA specific   RTOG toxicity and morbidity scales  
Irani J (51)  1999   Prospective or retrospective cohort study   Multi-institution   161   64   Not provided   Unable to determine from information provided   Survival only   
Iversen P (58)  1998   Randomized trial   Multi-institution   480   73   90% white, 0.3% black, 1.6% Hispanic   Non-metastatic disease   Survival   9 non-standard instruments  
         QOL-generic   
Jager GJ (82)  2000   Cost-effectiveness study   N/A   N/A   65   N/A   Non-metastatic disease   Survival   
         Quality adjusted survival   
         Estimated cost   
Jakobsson L (149)  1997   Cross-sectional study   Single institution   11   74   Not provided   Not provided   QOL-CA specific   EORTC QLQ-C30  
         QOL-generic   Sense of Coherence scale (SOC)  
Jakobsson L (150)  1997   Cross-sectional study   Single institution   11   74   Not provided   Not provided   QOL-CA specific   EORTC QLQ-C30  
Jakobsson L (151)  2000   Cross-sectional study   Single institution   25   67   Not provided   Not provided   Other type   Non-standard instrument  
Janda M (43)  2000   Randomized trial   Single institution   41   67   Not provided   Both   QOL-generic   MOS 36 Item Health Survey  
         QOL-CA specific   EORTC QLQ-C30  
Johnstone PA (152)  2000   Prospective or retrospective cohort study   Single institution   46   67   Not provided   Unable to determine from information provided   Survival   MOS 36 Item Health Survey  
         QOL-generic   UCLA-PCI  
         QOL-prostate CA specific   
Joly F (153)  1998   Cross-sectional study   Single institution   71   68   Not provided   Non-metastatic disease   QOL-generic   Nottingham Health Profile  
         QOL-prostate CA specific   EORTC QLQ-PR25  
         QOL-CA specific   EORTC QLQ-C30  
Jonler M (56)  1994   Cross-sectional study   Single institution   98   Grouped frequencies provided   Not provided   Non-metastatic disease   Survival   7 non-standard instruments  
         QOL-prostate CA specific   
         QOL-generic   
         Satisfaction   
Jonler M (154)  1996   Prospective or retrospective cohort study   Single institution   24   Grouped frequencies provided   Not provided   Non-metastatic disease   QOL-prostate CA specific   6 non-standard instruments  
         QOL-generic   
Jonler M (57)  1998   Cross-sectional study   Single institution   52   69   Not provided   Non-metastatic disease   Satisfaction   7 non-standard instruments  
         QOL-prostate CA specific   
         QOL-generic   
Jungi WF (155)  1998   Prospective or retrospective cohort study   Multi-institution   28   69   Not provided   Metastatic disease   QOL-CA specific   EORTC QLQ-C30  
         QOL-generic   WHO pain, performance, sub-scores  
Kantoff PW (37)  1999   Randomized trial   Multi-institution   242   72   90% white   Metastatic disease   Survival   Functional Living Index-Cancer (FLIC)  
         QOL-CA specific   EORTC QLQ-PR25  
         QOL-prostate CA specific   3 non-standard instruments  
         QOL-generic   
Kattan MW (89)  1997   Decision modeling   N/A   N/A   60-75   N/A   Non-metastatic disease   Survival   Time trade-off  
         Quality adjusted survival   
         Utilities   
Kim SP (27)  1999   Cross-sectional study   Multi-institution   116   69   52% black   Not provided   QOL-CA specific   EORTC QLQ-C30  
         QOL-generic   Functional Assessment of Cancer Therapy (FACT)  
         Satisfaction   Karnofsky Performance Index  
         Other type   Attitude Towards Care Questionnaire  
         Utilities   Time trade-off  
          2 non-standard instruments  
Knight SJ (28)  1998   Cross-sectional study   Multi-institution   110   71   62% black   Metastatic disease   QOL-CA specific   EORTC QLQ-C30  
         QOL-prostate CA specific   Functional Assessment of Cancer Therapy-Prostate (FACT-P)  
         QOL-generic   Karnofsky Performance Index  
          Non-standard instrument  
Kobeissi BJ (83)  1998   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Estimated cost   
Kornblith AB (156)  1994   Cross-sectional study   Single institution   172   68   96% white, 3% black, 1% Hispanic   Not provided   QOL-prostate CA specific   EORTC QLQ-PR25  
         QOL-generic   Intrusion subscale of the Impact Event Scale  
          QL Uniscale (Selby)  
          Non-standard instrument  
Krahn MD (72)  1994   Decision modeling   N/A   N/A   50-70   N/A   Screening   Survival   Time trade-off (proxy)  
         Quality adjusted survival   
         Cost   
         Estimated cost   
         Utilities   
Krahn MD (73)  1999   Cost-identification study   N/A   N/A   40-74   N/A   Both   Cost   
         Other   
Kramolowsky EV (84)  1995   Cost-identification study   N/A   N/A   Not provided   N/A   Not provided   Estimated cost   
         Other   
Kreis W (157)  1990   Prospective or retrospective cohort study   Multi-institution   118   69   Not provided   Metastatic disease   QOL-CA specific   ECOG performance status  
Krongrad A (158)  1997   Prospective or retrospective cohort study   Single institution   29   68   Not provided   Not provided   QOL-generic   Rand Mental Health Index  
         QOL-CA specific   Functional Living Index-Cancer (FLIC)  
Krongrad A (159)  1998   Cross-sectional study   HMO or managed care network   271   73   62% white   Not provided   QOL-generic   MOS 36 Item Health Survey UCLA-PCI  
         QOL-prostate CA specific   
Krupski T (160)  2000   Cross-sectional study   Single institution   138   Not provided   88% white, 11% black   Non-metastatic disease   Other type   AUA Index (IPSS)  
         QOL-CA specific   Functional Assessment of Cancer Therapy (FACT)  
         QOL-generic   2 non-standard instruments  
         QOL-prostate CA specific   
Kurtz ME (161)  1997   Cross-sectional study   Multi-institution   188   Not provided   Not provided   Not provided   QOL-generic   MOS 36 Item Health Survey  
Larson G (65)  2000   Cross-sectional study   Single institution   88   67   Not provided   Not provided   Survival Satisfaction QOL-prostate CA specific   2 non-standard instruments  
Leandri P (162)  1992   Prospective or retrospective cohort study   Single institution   620   68   Not provided   Non-metastatic disease   Survival QOL-prostate CA specific   2 non-standard instruments  
Lee WR (163)  1999   Prospective or retrospective cohort study   Single institution   46   68   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific Other type   Functional Assessment of Cancer Therapy-Prostate (FACT-P) Functional Assessment of Cancer Therapy (FACT) AUA Index (IPSS)  
Lee WR (164)  2000   Prospective or retrospective cohort study   Single institution   74   68   Not provided   Non-metastatic disease   Other type   AUA Index (IPSS)  
Licht MR (85)  1994   Cost-identification study   Single institution   272   62   Not provided   Non-metastatic disease   Estimated cost   
Lilleby W (165)  1999   Cross-sectional study   Single institution   262   65   Not provided   Not provided   QOL-CA specific Other type QOL-generic   EORTC QLQ-C30 AUA Index (IPSS) Non-standard instrument  
Lim AJ (59)  1995   Cross-sectional study   Single institution   196   69   77% white, 3% black, 10% Hispanic   Non-metastatic disease   QOL-CA specific QOL-generic QOL-prostate CA specific Satisfaction   Functional Living Index-Cancer (FLIC) Profile of Mood States (POMS) 2 non-standard instruments  
Litwin MS (166)  1995   Cross-sectional study   Single institution   214   73   60% white, 25% black, 10% Hispanic   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey Functional Assessment of Cancer Therapy (FACT) Cancer Rehabilitation Evaluation System UCLA-PCI  
Litwin MS (167)  1998   Prospective or retrospective cohort study   Single institution   63   72   79% white, 11% black, 6% Hispanic   Metastatic disease   Survival QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI  
Litwin MS (168)  1998   Cross-sectional study   Multi-institution   2252   71   Not provided   Not provided   QOL-generic QOL-prostate CA specific QOL-CA specific   MOS 36 Item Health Survey UCLA-PCI Karnofsky Performance Index Non-standard instrument  
Litwin MS (44)  1999   Prospective or retrospective cohort study   Multi-institution   438   64   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI  
Lubeck DP (169)  1997   Cross-sectional study   Multi-institution   2382   68   89.4% white, 6.7% black, 2.1% Hispanic   Both   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI 4 non-standard instruments  
Lubeck DP (170)  1999   Prospective or retrospective cohort study   Multi-institution   692   67   81.5% white, 10.4% black, 1.9% Hispanic   Both   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI 4 non-standard instruments  
Lucas MD (171)  1995   Prospective or retrospective cohort study   Single institution   15   76   Not provided   Metastatic disease    Quality of Life Index (Spitzer)  
Malmberg I (74)  1997   Cost-effectiveness study   N/A   N/A   Not provided   N/A   Metastatic disease   Survival Costs Estimated costs   
Mantz CA (172)  1999   Prospective or retrospective cohort study   Single institution   287   69   Not provided   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Maxon HR 3d (173)  1990   Non-randomized trial   Single institution   20   65   Not provided   Metastatic disease   QOL-prostate CA specific QOL-CA specific   Karnofsky Performance Index 3 non-standard instruments  
Mazur DJ (92)  1995   Decision modeling   N/A   N/A   35-84   N/A   Non-metastatic disease   Survival Utilities   Time trade-off (proxy)  
Mazur DJ (93)  1996   Decision modeling   N/A   N/A   30-85   N/A   Non-metastatic disease   Survival Utilities   Time trade-off (proxy)  
McCammon KA (60)  1999   Cross-sectional study   Single institution   460   Group information only   Not provided   Not provided   QOL-prostate CA specific Satisfaction   4 non-standard instruments  
Meng MV (174)  2000   Decision modeling   N/A   N/A   Not provided   N/A   Both   Other   
Meyer F (46)  1999   Prospective or retrospective cohort study   Community-based   384   67   Not provided   Both   Survival only   
Michalski JM (175)  2000   Non-randomized trial   Multi-institution   288   Not provided   Not provided   Non-metastatic disease   QOL-CA specific   RTOG toxicity and morbidity scales  
Moinpour CM (176)  1998   Randomized trial   Multi-institution   739   70   74% white, 25% black   Metastatic disease   QOL-CA specific QOL-generic   SWOG QOL questionnaire MOS 36 Item Health Survey  
Mold JW (94)  1992   Decision modeling   N/A   N/A   65   N/A   Screening   Survival Quality adjusted survival Utilities   Kaplan-Anderson Quality of Well Being Scale (proxy)  
Moore KN (177)  1999   Cross-sectional study   Multi-institution   63   67   Not provided   Not provided   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 Non-standard instrument  
Moore MJ (178)  1994   Non-randomized trial   Multi-institution   27   69   Not provided   Both   Survival QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 EORTC QLQ-PR25  
Mushinski M (75)  1996   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Costs Other   
Nicol DL (76)  1993   Cost-identification study   N/A   N/A   Not provided   N/A   Metastatic disease   Costs Other   
Oosterlinck W (179)  1996   Prospective or retrospective cohort study   Multi-institution   905   Not provided   Not provided   Both   QOL-prostate CA specific   Non-standard instrument  
Oosterlinck W (52)  1997   Prospective or retrospective cohort study   Multi-institution   546   74   Not provided   Non-metastatic disease   Survival only   
Osoba D (180)  1999   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   QOL-CA specific QOL-prostate CA specific   EORTC QLQ-C30 Prostate Cancer Specific QOL Instrument QOL module (QLM-P14, trial specific)  
Pannek J (181)  1997   Prospective or retrospective cohort study   Single institution   23   64   Not provided   Non-metastatic disease   Survival QOL-generic QOL-CA specific   2 non-standard instruments EMPK scales  
Patel BR (32)  1997   Non-randomized trial   Single institution   6   Not provided   Not provided   Metastatic disease   QOL-generic   Non-standard instrument  
Pedersen KV (182)  1993   Prospective or retrospective cohort study   Single institution   131   64   Not provided   Not provided   QOL-generic QOL-prostate CA specific   4 non-standard instruments  
Peetermans C (183)  1994   Non-randomized trial   Multi-institution   164   73   Not provided   Both   Survival QOL-generic   Non-standard instrument  
Perez MA (184)  1997   Cross-sectional study   Single institution   294   67   91% white   Not provided   QOL-prostate CA specific Other type   2 non-standard instruments  
Perrotte P (61)  1999   Prospective or retrospective cohort study   Single institution   112   68   92% white, 3% black   Non-metastatic disease   QOL-prostate CA specific Satisfaction   UCLA-PCI Non-standard instrument  
Pickles T (185)  1999   Randomized trial   Multi-institution   217   71   Not provided   Non-metastatic disease   Survival QOL-CA specific QOL-prostate CA specific   RTOG toxicity and morbidity scales 3 non-standard instruments  
Popov I (186)  1997   Prospective or retrospective cohort study   Single institution   15   65   Not provided   Metastatic disease   Other type   Rotterdam Symptom Checklist  
Porter AT (187)  1993   Randomized trial   Multi-institution   124   71   Not provided   Metastatic disease   Survival QOL-prostate CA specific QOL-generic   2 non-standard instruments  
Porterfield HA (188)  1997   Cross-sectional study   Community-based   1000   Grouped frequencies provided   94% white, 4% black   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Potosky AL (53)  1999   Prospective or retrospective cohort study   Medicare   21 741   Not provided   88% white, 7% black, 5% other   Both   Survival only   
Pousette A (54)  1999   Prospective or retrospective cohort study   Single institution   231   Not provided   Not provided   Not provided   Survival only   
Presti JC Jr (189)  1992   Randomized trial   Multi-institution   28   68   Not provided   Metastatic disease   QOL-generic QOL-CA specific   Karnofsky Performance Index Non-standard instrument  
Raghavan D (190)  1996   Prospective or retrospective cohort study   Multi-institution   50   67   Not provided   Metastatic disease   Survival QOL-prostate CA specific QOL-CA specific   ECOG performance status 2 non-standard instruments  
Rana A (55)  1993   Prospective or retrospective cohort study   Single institution   107   74   Not provided   Non-metastatic disease   Survival only   
Reddy SM (191)  1997   Cross-sectional study   Single institution   75   Not provided   Not provided   Non-metastatic disease   QOL-prostate CA specific   4 non-standard instruments  
Roach M 3rd (192)  1996   Cross-sectional study   Single institution   60   72   Not provided   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Robinson JW (193)  1999   Prospective or retrospective cohort study   Single institution   69   66   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific   Functional Assessment of Cancer Therapy-Prostate (FACT-P) Functional Assessment of Cancer Therapy (FACT)  
Rosendahl I (194)  1999   Randomized trial   Multi-institution   297   Not provided   Not provided   Metastatic disease   Survival Other type   Q-twist  
Rossetti SR (62)  1996   Prospective or retrospective cohort study   Single institution   161   Not provided   Not provided   Not provided   Survival Satisfaction   Non-standard instrument  
Roth AJ (195)  1998   Cross-sectional study   Single institution   121   71   88% white   Both   QOL-generic QOL-CA specific   Hospital anxiety and depression scale (HADS) Non-standard instrument  
Sall M (196)  1997   Prospective or retrospective cohort study   Single institution   24   61   Not provided   Non-metastatic disease   QOL-prostate CA specific QOL-generic   Wisconsin Brief Pain Inventory 2 non-standard instruments  
Santis WF (197)  2000   Prospective or retrospective cohort study   Single institution   100   62   Not provided   Not provided   QOL-prostate CA specific   Non-standard instrument  
Sarosdy MF (198)  1999   Prospective or retrospective cohort study   Multi-institution   59   70   56% white, 29% black, 13% Hispanic   Non-metastatic disease   QOL-prostate CA specific   Non-standard instrument  
Schag CA (199)  1994   Cross-sectional study   Multi-institution   104   70   92% white, 4% black, 4% Hispanic   Non-metastatic disease   QOL-CA specific   Cancer Rehabilitation Evaluation System QOL Linear analogue self assessment (QOL-LASA)  
Schroder FH (200)  2000   Randomized trial   Multi-institution   294   71   Not provided   Not provided   QOL-prostate CA specific   Non-standard instrument  
Seidenfeld J (201)  2000   Meta-analysis   Multi-institution   6600   Not provided   Not provided   Unable to determine from information provided   Survival QOL-prostate CA specific QOL-CA specific   Non-standard instrument Functional Living Index-Cancer (FLIC)  
Sharp LK (29)  1999   Prospective or retrospective cohort study   Multi-institution   110   72   35% white, 62% black   Metastatic disease   QOL-CA specific QOL-generic   EORTC QLQ-C30 Functional Assessment of Cancer Therapy (FACT) Quality of Life Index (Spitzer) Karnofsky Performance Index  
Shrader-Bogen CL (202)  1997   Cross-sectional study   Single institution   274   71   95% white, 1% Hispanic   Non-metastatic disease   QOL-prostate CA specific QOL-CA specific   Prostate Cancer Treatment Outcome Questionnaire Functional Assessment of Cancer Therapy (FACT)  
Shukla SK (203)  1997   Non-randomized trial   Other   31   65   Not provided   Metastatic disease   Other type   Non-standard instrument  
Singer PA (95)  1991   Decision modeling   N/A   N/A   45-70   N/A   Non-metastatic disease   Survival Utilities   Trade-off (proxy, survival vs. potency)  
Small EJ (38)  2000   Randomized trial   Multi-institution   460   68   91% white, 9% black, 1% other   Metastatic disease   Survival QOL-CA specific Other type QOL-generic   Functional Assessment of Cancer Therapy (FACT) Revised Rand Functional Limitations Scale (RRFLS) Non-standard instrument  
Smathers S (204)  2000   Cross-sectional study   Single institution   58   Not provided   Not provided   Not provided   Other type Satisfaction   3 non-standard instruments  
Smith DC (39)  1999   Prospective or retrospective cohort study   Single institution   37   64   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific   Functional Assessment of Cancer Therapy (FACT) Functional Assessment of Cancer Therapy-Prostate (FACT-P) National Cancer Institute Common Toxicity Criteria  
Smith DS (205)  2000   Cross-sectional study   Single institution   1651   70   Not provided   Non-metastatic disease   QOL-generic QOL-prostate CA specific   MOS 36 Item Health Survey UCLA-PCI Non-standard instrument  
Smith MF (206)  1990   Non-randomized trial   Single institution   24   70   Not provided   Metastatic disease   Survival QOL-generic   3 non-standard instruments  
Soloway MS (207)  1996   Randomized trial   Multi-institution   813   70   72% white, 23% black   Metastatic disease   Survival QOL-generic   Non-standard instrument  
Souchek J (40)  2000   Prospective or retrospective cohort study   Multi-institution   120   72   68.3% white, 27.5% black   Metastatic disease   Utilities   Time trade-off Standard Gamble 1 non-standard instrument  
Stier DM (208)  1999   Cross-sectional study   Multi-institution   1638   68   97% white   Not provided   QOL-generic QOL-CA specific   MOS 36 Item Health Survey TIBI- total illness burden index TIBI-P total illness burden index-prostate  
Stockler MR (209)  1998   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   EORTC QLQ-C30 Prostate Cancer Specific QOL Instrument QOL module (QLM-P14, trial specific) Present Pain Intensity (PPI)  
Stockler MR (210)  1999   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   EORTC QLQ-C30 Prostate Cancer Specific QOL Instrument QOL module (QLM-P14, trial specific) Present Pain Intensity (PPI)  
Stone P (211)  2000   Cross-sectional study   Single institution   62   69   89% white, 1% black   Both   QOL-CA specific QOL-prostate CA specific Other type QOL-generic   EORTC QLQ-C30 Functional Assessment of Cancer Therapy-Prostate (FACT-P) Fatigue Severity Scale (FSS) Bidimensional Fatigue Scale (BFS) Hospital anxiety and depression scale (HADS)  
Tannock IF (212)  1996   Randomized trial   Multi-institution   161   68   Not provided   Metastatic disease   Survival QOL-CA specific QOL-prostate CA specific QOL-generic   EORTC QLQ-C30 EORTC QLQ-PR25 Prostate Cancer Specific QOL Instrument Present Pain Intensity (PPI) Non-standard instrument  
Taplin SH (86)  1995   Cost-identification study   N/A   N/A   35-80   N/A   Both   Estimated cost   
Tefilli MV (213)  1998   Cross-sectional study   Single institution   68   66   Not provided   Non-metastatic disease   Survival QOL-prostate CA specific QOL-CA specific   Functional Assessment of Cancer Therapy-Prostate (FACT-P) Functional Assessment of Cancer Therapy (FACT)  
Tyrrell CJ (214)  1998   Randomized trial   Multi-institution   1288   72   98% white, 1% black   Metastatic disease   Survival QOL-prostate CA specific   Non-standard instrument  
Ullman M (77)  1996   Cost-identification study   N/A   N/A   Not provided   N/A   Both   Costs other   
van Andel G (215)  1997   Cross-sectional study   Multi-institution   55   Not provided   Not provided   Metastatic disease   QOL-CA specific Other type QOL-generic   EORTC QLQ-C30 AUA Index (IPSS) QL Uniscale (Selby) Non-standard instrument  
van Andel G (41)  2000   Randomized trial   Multi-institution   26   68   Not provided   Metastatic disease   Survival Other type QOL-CA specific   Rotterdam Symptom Checklist Non-standard instrument  
Volk RJ (96)  1997   Decision modeling   N/A   N/A   50   N/A   Screening   Quality adjusted survival Utilities   Time trade-off (proxy)  
Wagner TT (216)  1999   Cost-identification study   N/A   N/A   Not provided   N/A   Non-metastatic disease   Hospital Charges   
Walsh PC (217)  1994   Prospective or retrospective cohort study   Single institution   955   59   Not provided   Non-metastatic disease   Survival QOL-prostate CA specific   2 non-standard instruments  
Wang H (30)  2000   Cross-sectional study   Single institution   72   70   16.7% white, 80.6% black, 2.8% Hispanic   Unable to determine from information provided   QOL-generic QOL-prostate CA specific   3 non-standard instruments  
Wei JT (218)  2000   Prospective or retrospective cohort study   Single institution   145   62   Not provided   Non-metastatic disease   Other type   Non-standard instrument  
Wilt TJ (219)  1997   Randomized trial   Multi-institution   238   67   68% white, 24% black   Non-metastatic disease   QOL-generic   Non-standard instrument  
Wolf JS Jr (78)  1995   Cost-effectiveness study   N/A   N/A   Not provided   N/A   Both   Costs Estimated costs Utilities   Utility values calculated (proxy)  
Yao SL (33)  1999   Cross-sectional study   Community-based   101 604   69   89.5% white, 5.1% black, 5.4% Hispanic   Not provided   Survival only   
Yarbro CH (220)  1998   Cross-sectional study   Single institution   121   72   97% white   Unable to determine from information provided   QOL-prostate CA specific QOL-generic   UCLA-PCI Quality of Life Index (Spitzer)  
Yoshimura N (99)  1998   Decision modeling   N/A   N/A   60   N/A   Non-metastatic disease   Survival Quality adjusted survival Utilities   Utilities estimated from literature  
Zwetsloot-Schonk JH (97)  1993   Decision modeling   N/A   N/A   62   N/A   Both   Survival Quality adjusted survival Utilities   Utility values calculated (proxy)  

Table 1.

Reasons for exclusion of 199 papers

Reason for exclusion   No. studies (%)  
Review article   62 (31)  
No appropriate patient centered outcome (i.e., only laboratory values)   49 (25)  
Assessments of baseline knowledge, attitudes, etc.   38 (19)  
Data not collected from patients (i.e., doctors, nurses, patient proxies)   11 (5.5)  
Questionnaire or assessment tool validation study   9 (5)  
Descriptive only   8 (4)  
Methodology or basic science papers   7 (3.5)  
Consensus panel/guidelines report   5 (3)  
Focus on other disease(s)   4 (2)  
Same study published in multiple sources   4 (2)  
No primary data   2 (1)  
Total   199 (100)  
Reason for exclusion   No. studies (%)  
Review article   62 (31)  
No appropriate patient centered outcome (i.e., only laboratory values)   49 (25)  
Assessments of baseline knowledge, attitudes, etc.   38 (19)  
Data not collected from patients (i.e., doctors, nurses, patient proxies)   11 (5.5)  
Questionnaire or assessment tool validation study   9 (5)  
Descriptive only   8 (4)  
Methodology or basic science papers   7 (3.5)  
Consensus panel/guidelines report   5 (3)  
Focus on other disease(s)   4 (2)  
Same study published in multiple sources   4 (2)  
No primary data   2 (1)  
Total   199 (100)  

Data Abstraction Technique

A data abstraction form was developed, pretested, revised, and finalized for this study. For papers excluded after review, only the reason or reasons for the exclusion were recorded. Each included paper was assigned one primary, mutually exclusive study design: randomized trial, nonrandomized trial, cohort study, case-control study, cross-sectional study, meta-analysis, decision modeling, cost-identification study, cost-effectiveness study, or cost-benefit study. We then abstracted different information for the first six design categories (generally presenting primary data on actual patient outcomes, the “ primary data” studies) and the last four categories (the “ economic and decision analytic” papers, usually presenting outcomes data on hypothetical patients).

For the primary data papers, available information was abstracted on the care setting, dates of the study, racial distribution of the study population, mean or median age, and total sample size. Distributions of tumor differentiation (well, moderate, or poor) and cancer stage were also abstracted when presented, and whether survival was reported was noted. For those papers included from the update search, whether statistical power and clinical importance of observed differences were discussed, and whether confidence intervals were provided around point estimates of measured outcomes, was also noted. Finally, all patient-centered outcome measures were enumerated. The measures included single and multi-item patient questionnaires, addressing different aspects of the effect of prostate cancer screening and treatment on the lives of men. Reviewers were provided a menu of standard published health-related QOL (HRQOL) questionnaires used in prostate cancer outcome studies and could record an unlimited number of additional outcome measures for each study. Reviewers also indicated whether, using their best judgment, these questionnaires were primarily addressing overall HRQOL, cancer-specific HRQOL, prostate cancer-specific HRQOL, patient satisfaction, risk-based utilities for different health states, or other domains.

For the economic and decision analytic papers, available information was abstracted on stage of disease (localized or metastatic), age range, outcomes (survival and quality-adjusted survival), costs, and whether utilities were measured. For utilities, whether patients or proxies completed utility assessments was reported.

Statistical Analysis

Completed abstraction forms were entered into an Access database and imported into SAS (SAS Institute, Cary, NC) for analysis. Trends in the proportion of papers using standard HRQOL measures and presenting age and race data were assessed with the chi-square test for trend (22).

Results

Distribution of Study Designs for Included Papers

Of the 198 included papers, there were 161 (81%) “primary data papers” categorized as follows: randomized trial (n = 28), nonrandomized trial (n = 13), prospective or retrospective cohort study (n = 55), case-control study (n = 0), cross-sectional study (n = 63), and meta-analysis (n = 2). The 37 “economic and decision analytic papers” consisted of 17 decision modeling studies, 13 cost-identification studies, and 7 cost-effectiveness studies (Table 2).

Table 2.

Study design for 198 reviewed papers

Design   No. of studies  
Primary data studies   161  
     Randomized trial   28  
     Non-randomized trial   13  
     Prospective or retrospective cohort study   55  
     Cross-sectional study   63  
     Meta-analysis   2  
Economic and decision analytic studies   37  
     Decision modeling   17  
     Cost identification study   13  
     Cost effectiveness study   7  
Design   No. of studies  
Primary data studies   161  
     Randomized trial   28  
     Non-randomized trial   13  
     Prospective or retrospective cohort study   55  
     Cross-sectional study   63  
     Meta-analysis   2  
Economic and decision analytic studies   37  
     Decision modeling   17  
     Cost identification study   13  
     Cost effectiveness study   7  

Characteristics of Study Populations

Information on the study populations in the primary data papers was often incomplete. Dates of data collection were missing 40% of the time.

Age and Race

Of the 161 primary data studies, 28 (17%) did not report the age of their subjects. The median value of the mean/median ages of the studies reporting this variable was 68 (interquartile range = 67-71). Only 53 (33%) of the 161 studies described the racial distribution of the study populations, although a number of the studies that did not provide a racial distribution were from countries with fairly homogenous populations. Fifty papers provided a proportion of whites in the study population (median proportion = 88%), 38 papers provided information on blacks (median proportion = 11%), 16 papers provided information on Hispanics (median proportion 3.4%), and 6 papers provided a proportion of “other” races (median = 1.3%). Although prostate cancer has a higher incidence and mortality among African Americans, only eight studies (23-30) had a preponderance of black subjects, and the sample sizes of these studies were limited (range of number of African American subjects, 42-132). The study with the largest sample size of African American men was a screening study with 51% white men and 44% African American men (n = 415). (31)

Tumor Stage and Grade

Almost one-quarter (24%) of primary data studies did not include stage of disease, and another 4% reported incomplete data. More than three-quarters (77%) of these papers did not report tumor grades. Of those papers that reported information on grade distribution, the median proportion of poorly differentiated tumors was 22%, moderately differentiated tumors was 53%, and well-differentiated tumors was 19.5%. Not all papers reported on all categories.

Sample Size and Power Calculations

The median sample size for the 161 primary data studies was 125.5 (interquartile range = 58-281). The smallest study (32) was a study of six men with metastatic prostate cancer who were treated with strontium chloride Sr 89 for their painful bone metastases, and whose clinical response was determined by a series of clinical notes and patient observations which might generally reflect QOL, although no details of the assessment were given. The largest study (33) was a comparison of prostate cancer treatment practices and 10-year survival outcomes in health maintenance organization and fee-for service populations. Of the 43 primary data studies reviewed after the updated search, nine (21%) discussed statistical power (33-41), six (14%) discussed the clinical importance of observed differences (34,37,38,42-44), and eight (19%) reported confidence intervals (33-35,37,38,41,45,46). These three variables were not included in the abstraction form for the original search.

Care Setting

The care settings for the 161 primary data papers were categorized as follows: single institution (n = 82), multi-institution (n = 65), community-based (n = 7), health maintenance organization or managed care (n = 1), large U.S. population-based database (Medicare; Surveillance, Epidemiology, and End Results; n = 3), and miscellaneous (n = 3; patients from a prostate cancer support group [n = 1], meta-analysis of Medline papers [n = 1], and not reported [n = 1]).

Type of Outcome Measured

Of the 161 primary data papers, survival was reported in 55 (34%) of reviewed papers; 12 papers reported survival data alone (33,45-55). Of note, there are likely to be survival papers that were not included in our review, because of the specifications of our search strategy. Among the 149 primary data papers that contained patient outcome data, there were 42 standard instruments used, accounting for 44% (179 of 410) of the measures overall. Almost three-quarters (71%) of papers included one, two, or three outcomes measures of all types (standard and nonstandard). Three papers included seven outcome measures (27,56,57), and one included nine (58).Table 3 shows the types of outcomes measured and the number of papers using the various types of outcome measures.

Table 3.

Type of outcome measured in 198 reviewed papers (categories are not mutually exclusive)

Type of outcome   No. studies (%)  
Health related quality of life   
     Generic   77 (39)  
     Cancer specific   63 (32)  
     Prostate cancer specific   88 (44)  
Satisfaction   12 (6)  
Economic and decision analytic   
     Decision modeling   17 (9)  
     Cost identification   13 (7)  
     Cost effectiveness   7 (4)  
Type of outcome   No. studies (%)  
Health related quality of life   
     Generic   77 (39)  
     Cancer specific   63 (32)  
     Prostate cancer specific   88 (44)  
Satisfaction   12 (6)  
Economic and decision analytic   
     Decision modeling   17 (9)  
     Cost identification   13 (7)  
     Cost effectiveness   7 (4)  

Specific Instruments Used by Type of Outcome Measured

Table 4 shows the specific instruments used within each outcome type and the number of uses of the various instruments among the 149 primary data papers measuring outcomes other than survival. The SF-36 was the most commonly used QOL-generic instrument, the EORTC QLQ-C30 was the most commonly used QOL-cancer specific instrument, and the UCLA-PCI was the most commonly used QOL-prostate cancer specific instrument.

Table 4.

Frequency of use of standard instruments measured in 149 primary data papers that measured outcomes other than survival, by type of outcome

Instrument   No. of studies (%)  
QOL-generic   
     Nottingham Health Profile   1 (0.7)  
     EMPK scales   1 (0.7)  
     EuroQol-5d   1 (0.7)  
     Psychosocial Adjustment to Illness (PAIS)   1 (0.7)  
     Revised Rand Functional Limitations Scale (RRFLS)   1 (0.7)  
     TIBI—total illness burden index   1 (0.7)  
     Rand Mental Health Index   1 (0.7)  
     Sense of Coherence scale (SOC)   1 (0.7)  
     Hospital anxiety and depression scale (HADS)   2 (1.3)  
     Wisconsin Brief Pain Inventory   2 (1.3)  
     Speilberger state-trait anxiety inventory   2 (1.3)  
     Intrusion subscale of the Impact Event Scale   3 (2.0)  
     Present Pain Intensity (PPI)   3 (2.0)  
     Quality of Life Index (Spitzer)   3 (2.0)  
     Profile of Mood States (POMS)   4 (2.7)  
     QL Uniscale (Selby)   4 (2.7)  
     WHO pain, performance, Other scores   6 (4.0)  
     MOS 36 Item Health Survey   17 (11.4)  
     Other   70 (46.9)  
QOL-cancer specific   
     QOL Linear analogue self assessment (QOL-LASA)   1 (0.7)  
     SWOG QOL questionnaire   1 (0.7)  
     National Cancer Institute Common Toxicity Criteria   1 (0.7)  
     Cancer Rehabilitation Evaluation System   2 (1.3)  
     ECOG performance status   3 (2.0)  
     RTOG toxicity and morbidity scales   6 (4.0)  
     Karnofsky Performance Index   7 (4.7)  
     Functional Living Index-Cancer (FLIC)   8 (5.4)  
     Other   10 (6.7)  
     Functional Assessment of Cancer Therapy (FACT)   11 (7.4)  
     EORTC QLQ-C30   28 (18.8)  
QOL-prostate cancer specific   
     Prostate Cancer Treatment Outcome Questionnaire   1 (0.7)  
     Radiumhemmets Scale of Sexual Function   1 (0.7)  
     ICS-Male questionnaire   1 (0.7)  
     TIBI-P total illness burden index-prostate   1 (0.7)  
     QOL module (QLM-P14, trial specific)   3 (2.0)  
     Prostate Cancer Specific QOL Instrument   4 (2.7)  
     Functional Assessment of Cancer Therapy-Prostate (FACT-P)   7 (4.7)  
     EORTC QLQ-PR25   11 (7.4)  
     UCLA-PCI   14 (9.4)  
     Other   110 (73.8)  
Satisfaction   
     Other   12 (8.0)  
Costs   
     Other   1 (0.7)  
Utilities   
     Standard Gamble   1 (0.7)  
     Health Utility Index   1 (0.7)  
     Other   2 (1.3)  
     Time trade-off   5 (3.4)  
Other type   
     Q-twist   1 (0.7)  
     Bidimensional Fatigue Scale (BFS)   1 (0.7)  
     Fatigue Severity Scale (FSS)   1 (0.7)  
     Rotterdam Symptom Checklist   4 (2.7)  
     AUA Index (IPSS)   7 (4.7)  
     Other   19 (12.8)  
Instrument   No. of studies (%)  
QOL-generic   
     Nottingham Health Profile   1 (0.7)  
     EMPK scales   1 (0.7)  
     EuroQol-5d   1 (0.7)  
     Psychosocial Adjustment to Illness (PAIS)   1 (0.7)  
     Revised Rand Functional Limitations Scale (RRFLS)   1 (0.7)  
     TIBI—total illness burden index   1 (0.7)  
     Rand Mental Health Index   1 (0.7)  
     Sense of Coherence scale (SOC)   1 (0.7)  
     Hospital anxiety and depression scale (HADS)   2 (1.3)  
     Wisconsin Brief Pain Inventory   2 (1.3)  
     Speilberger state-trait anxiety inventory   2 (1.3)  
     Intrusion subscale of the Impact Event Scale   3 (2.0)  
     Present Pain Intensity (PPI)   3 (2.0)  
     Quality of Life Index (Spitzer)   3 (2.0)  
     Profile of Mood States (POMS)   4 (2.7)  
     QL Uniscale (Selby)   4 (2.7)  
     WHO pain, performance, Other scores   6 (4.0)  
     MOS 36 Item Health Survey   17 (11.4)  
     Other   70 (46.9)  
QOL-cancer specific   
     QOL Linear analogue self assessment (QOL-LASA)   1 (0.7)  
     SWOG QOL questionnaire   1 (0.7)  
     National Cancer Institute Common Toxicity Criteria   1 (0.7)  
     Cancer Rehabilitation Evaluation System   2 (1.3)  
     ECOG performance status   3 (2.0)  
     RTOG toxicity and morbidity scales   6 (4.0)  
     Karnofsky Performance Index   7 (4.7)  
     Functional Living Index-Cancer (FLIC)   8 (5.4)  
     Other   10 (6.7)  
     Functional Assessment of Cancer Therapy (FACT)   11 (7.4)  
     EORTC QLQ-C30   28 (18.8)  
QOL-prostate cancer specific   
     Prostate Cancer Treatment Outcome Questionnaire   1 (0.7)  
     Radiumhemmets Scale of Sexual Function   1 (0.7)  
     ICS-Male questionnaire   1 (0.7)  
     TIBI-P total illness burden index-prostate   1 (0.7)  
     QOL module (QLM-P14, trial specific)   3 (2.0)  
     Prostate Cancer Specific QOL Instrument   4 (2.7)  
     Functional Assessment of Cancer Therapy-Prostate (FACT-P)   7 (4.7)  
     EORTC QLQ-PR25   11 (7.4)  
     UCLA-PCI   14 (9.4)  
     Other   110 (73.8)  
Satisfaction   
     Other   12 (8.0)  
Costs   
     Other   1 (0.7)  
Utilities   
     Standard Gamble   1 (0.7)  
     Health Utility Index   1 (0.7)  
     Other   2 (1.3)  
     Time trade-off   5 (3.4)  
Other type   
     Q-twist   1 (0.7)  
     Bidimensional Fatigue Scale (BFS)   1 (0.7)  
     Fatigue Severity Scale (FSS)   1 (0.7)  
     Rotterdam Symptom Checklist   4 (2.7)  
     AUA Index (IPSS)   7 (4.7)  
     Other   19 (12.8)  

There were no standard measures of satisfaction used, although 12 papers mentioned that satisfaction was measured in some way. One paper (27) used an “Attitudes towards care questionnaire” adopted from the 43 item patient satisfaction questionnaire used in the Medical Outcomes Study. Of the remaining 11 papers that measured satisfaction, six used a general question about overall satisfaction with treatment (56,57,59-62), and six asked a question about whether the patient would choose the treatment again (56,57,59,60,62,63). Two studies asked a single question about whether the patient would recommend a treatment to someone else (64,65), and two studies asked about patients' confidence in their doctors (59,62). One paper stated that patients were asked about their satisfaction with the information their physicians presented and about their satisfaction with the treatment options they received (26).

Among the 37 economic and decision analytic papers, 13 measured some or all costs directly (66-78), and 14 used estimated costs either in combination with actual measured costs or alone (66,67,70,72,74,78-86). One primary data paper included a measurement of costs, using actual economic costs as well as charges and estimates (87).

There were five primary data papers that measured utilities (23,24,27,40,88). The utility assessment methodologies included were time trade-off (n = 5) (23,24,27,40,88), standard gamble (n = 1) (27), Health Utility Index (n = 1) (40), and analog (40) or rating (27) scales (each used once).

Among the 37 economic and decision analytic papers, 16 papers measured patient utilities. These studies included two that measured utilities directly from patients (67,89), 11 that used proxies to measure utilities (72,78,80,90-97), and one that used both methods (98). Two papers did not supply enough information to allow determination of whether the utilities were obtained from patients or proxies (79,99). Of the three that included utilities measured directly from patients, two used time trade-off assessments (89,98) and one a QOL scale transformation using a previously published technique (67). Of the 12 papers that used proxy utility measurements, eight used time trade-off (72,80,90-93,96,98), one used a trade-off measurement of survival versus potency (95), two calculated their utility measurements (78,97), and one used an instrument called the Kaplan-Anderson Well-Being Scale (94).

Phase of Care

Table 5 shows the number of papers that examined patients in various phases of prostate cancer screening and treatment by study design. There were seven screening papers, two prospective cohort studies (31,100), and five economic and decision analytic studies (72,81,90,94,96). Forty-five papers (23%) did not provide data or provided incomplete data on cancer stage, making an assignment of phase of care impossible (31 [49%] cross-sectional studies, 10 [18%] cohort studies, two [7%] randomized trials, one [50%] meta-analysis, and one [8%] cost-identification study). Among treatment papers, studies of patients with nonmetastatic disease (65 papers) were more common than studies of patients with metastatic disease (49 papers) or both (32 papers).

Table 5.

Study design by phase of care for 198 studies

  Design  
Phase of care   Randomized trial (n = 28)   Non-randomized trial (n = 13)   Prospective or retrospective cohort study (n = 55)   Cross-sectional study (n = 63)   Meta-analysis (n = 2)   Decision modeling (n = 17)   Cost identification study (n = 13)   Cost effectiveness study (n = 7)  
Screening (n = 7)   0   0   2   0   0   5   0   0  
Non-metastatic cancer (n = 65)   5   2   24   19   1   8   4   2  
Metastatic cancer (n = 49)   18   9   13   4   0   0   2   3  
Both metastatic and non-metastatic (n = 32)   3   2   6   9   0   4   6   2  
Incomplete/no information (n = 45)   2   0   10   31   1   0   1   0  
  Design  
Phase of care   Randomized trial (n = 28)   Non-randomized trial (n = 13)   Prospective or retrospective cohort study (n = 55)   Cross-sectional study (n = 63)   Meta-analysis (n = 2)   Decision modeling (n = 17)   Cost identification study (n = 13)   Cost effectiveness study (n = 7)  
Screening (n = 7)   0   0   2   0   0   5   0   0  
Non-metastatic cancer (n = 65)   5   2   24   19   1   8   4   2  
Metastatic cancer (n = 49)   18   9   13   4   0   0   2   3  
Both metastatic and non-metastatic (n = 32)   3   2   6   9   0   4   6   2  
Incomplete/no information (n = 45)   2   0   10   31   1   0   1   0  

Time Trends Across the Decade for Use of Standard HRQOL Instruments, Age, and Race

To assess time trends from 1990 to 2000 (11 years), the primary data papers were grouped by publication date into three time periods: 1990 to 1993, 1994 to 1997, and 1998 to 2000, representing the early, middle, and late years of the decade. Table 6 shows a non-statistically significant trend toward more frequent use of standardized HRQOL instruments over the 11-year time frame, no trend toward more frequent reporting of age, and a statistically significant trend toward increased reporting of at least some information on race (P = .003).

Table 6.

Trend over time in use of standard HRQOL measures, and in reporting of age and race in 161 primary data papers

Year of publication   No. (%) using standard HRQOL measures N = 149*  No. (%) reporting age information N = 161   No. (%) reporting race information N = 161  
*Denominator is 149 papers reporting outcomes besides survival.  
† Chi-square test for trend.  
1990-1993   6 (46%)   12 (80%)   1 (7%)  
1994-1997   30 (54%)   46 (77%)   16 (27%)  
1998-2000   50 (63%)   75 (87%)   36 (42%)  
P for trend†  P = .2  P = .2  P = .003  
Year of publication   No. (%) using standard HRQOL measures N = 149*  No. (%) reporting age information N = 161   No. (%) reporting race information N = 161  
*Denominator is 149 papers reporting outcomes besides survival.  
† Chi-square test for trend.  
1990-1993   6 (46%)   12 (80%)   1 (7%)  
1994-1997   30 (54%)   46 (77%)   16 (27%)  
1998-2000   50 (63%)   75 (87%)   36 (42%)  
P for trend†  P = .2  P = .2  P = .003  

Discussion

Strengths and Limitations of Prostate Cancer Outcomes Research to Date

Strengths of the literature. There are a number of published, validated prostate cancer-specific HRQOL indices, and as can be seen in Table 4, these measures were used in many of the studies included in our review. Also, over time, standard HRQOL instruments tended to be used more frequently, although this trend was not statistically significant. Finally, there was a statistically significant trend over the decade toward improved reporting of basic demographic information, such as race.

Limitations of the literature. The recent literature describing the outcomes of prostate cancer screening and treatment is flawed in many respects. First, many studies relied on unvalidated instruments, despite the availability of published, validated measures. Second, when validated instruments were used, studies did not use the same ones. Thus, the heterogeneity in outcomes measures made it almost impossible to compare results across studies. Third, very few studies examined patient-centered screening outcomes. Fourth, relatively few randomized trials addressed treatment options for men with advanced disease. Fifth, non-experimental studies tended to be cross-sectional in nature, lacking data on subjects' baseline demographics and condition before diagnosis and treatment, and not allowing assessment of how prostate cancer patients' qualities of life evolve over time. This problem is particularly important, because many prostate cancer patients, even those men with advanced disease, survive for years.

Limitations of this Systematic Review

The search strategy was developed favoring specificity, perhaps at the expense of some sensitivity. A broader search strategy might well have identified additional papers with patient-centered outcomes data from patients screened or treated for prostate cancer. However, it is likely that the papers we identified, which were specifically categorized as having relevant outcomes data in Medline, are representative of the body of literature we did not identify.

Recommendations for Outcomes Measurement in Prostate Cancer

In general, the message to the research community interested in prostate cancer screening and treatment outcomes is clear. First, there needs to be consensus on which validated instruments, both generic and disease-specific, should be regarded as the gold standard for measuring prostate cancer screening and treatment outcomes, and then this core set of questions should be asked in every study, although investigators should be encouraged to include additional question sets as appropriate to individual studies to get a more complete picture of how men screened and treated for prostate cancer are doing over time.

See “Note” following “References.”
This work was supported by contracts from the National Cancer Institute, National Institutes of Health. Dr. McNaughton-Collins is a recipient of a Doris Duke Clinical Scientist Award.

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