Qualidade de vida em pacientes submetidos à prostatectomia radical

Abstract

Introduction: Prostate cancer (CaP) is among men the second malignant tumor and the second most prevalent cause of death in cancer. Two features are peculiar: the incidence increases with age and the indolent character in most cases. Studies about CaP are relevant due to the high incidence and high cure rates when diagnosed in early stages. Radical prostatectomy (RP) is the gold standard for localized tumors. As surgical complications include erectile dysfunction (ED) and urinary incontinence (UI) that eventually compromise the self-esteem (SE), sexual performance and quality of life (QoL). Objective: To evaluate the QoL of patients undergoing RP in the last five years. Specific objectives: to characterize patients and relate QoL to age, postoperative period, ED, UI, SE and sexual performance. Methodology: This was an observational, cross-sectional correlational study with 81 patients. Instruments were used to characterize socio-demographical, clinical- surgical and variables of interest. Through the SPSS software it was performed a descriptive analysis, Chisquare test of Pearson and the nonparametric tests of Mann-Whitney test, Pearson and Spearman, according to Shapiro Wilk normality test. The internal consistency of the scales was assessed by Cronbach's alpha. Results: Average age was 65.7 (D.P. =8.4). It was obtained a higher percentage of patients aged 60 years or more (77.8%), Caucasian (63%), married / cohabiting (80.3%), living with one or two dependents (54.3%) , incomplete elementary education (84%), retired (75.3%) and monthly income of a minimum wage (54.3%). Reported former smoking (49.4%), hypertension (53.1%), diabetes mellitus (17.8%) and heart disease (27.2%). 51.9% had a healthy BMI. Asymptomatic searched the urology service (85.2%). Staging prevailed T2c to T3 (74.1%), Gleason &#8804; 6 (63%), preoperative PSA 4.1 to 10 ng/ml (59.3%) and high risk (76.6%). The average postoperative period was 25.9 months (6 to 48.4) with most held for more than one year (76.5%). ED was present in 90.1% and 33.3% in the UI. The association between ED and age revealed that older adults had higher ED when compared to adults (p=0.01). The SE had a mean of 5.38. QSM revealed that 70.4% had zero to bad performance. SE was observed to be worse (p=0.019) and worse sexual performance (p<0.001) in patients with ED. QoL showed to be good with high rates on functional scales and on global health scale, and low in symptomatology. It turned out better QoL in the elderly compared to adults in items: emotional function (p=0.03), financial difficulties (p=0.03) and EGS (p=0.02) and those with more than one year of surgery in items: cognitive function and fatigue (p=0.03). A worsening of insomnia in patients with urinary incontinence (p =0.04) was observed. The correlation between QoL and SE showed to be strong in items: social function and global health scale. Conclusion: The possible sequels of RP can change male sexuality although major impact on QoL has not been observed.