**2. QOL changes after treatment for localized prostate cancer**

There are few changes in general HRQOL after a retropubic radical prostatectomy (RRP) or interstitial brachytherapy.1-3 However, disease-specific QOL, especially bowel function and urinary irritative symptoms, is worse in the interstitial brachytherapygroup, and urinary incontinence and sexual function are worse in the RRP group.1 Hamada *et al.* evaluated QOL immediately before surgery and at several points during the 6-month period after retropubic radical prostatectomy (RRP). They reported that a radical prostatectomy aggravates the Social/Family well-being score and the FACT-P score.4 Other studies have also showed that prostatectomy and interstitial brachytherapy continuously decreased health-related QOL.5-8 Hanlon *et al.* showed that external beam radiotherapy for localized prostate cancer aggravates bowel function.9 Hubosky *et al.* reported that HRQOL showed patients undergoing cryoablation on average achieved urinary and bowel domain scores

A Review of Quality of Life Following Treatments for Localized Prostate Cancer 359

Hubosky *et al.* reported that the urinary function was similar for the groups of patients treated with cryoablation and brachytherapy until 18 months, at which time cryoablation

We reported that the QOL index improved significantly at 6 months after HIFU therapy. Our data on uroflowmetry showed that maximum flow rate and residual urine volume were significantly impaired at 6 months after HIFU. However, the data on maximum flow rate

It is important to preserve erectile function during treatment of prostate cancer. Postoperative potency depends on the preservation of neurovascular bundles (NVB), which

Hanlon *et al.* reported a normal potency rate at 1 year after treatment of 50% for patients in the RRP group, 65% for patients in the brachytherapy group, and 69% for patients in the

Generally, the potency rate is aggravated by injury to NVB after radical prostatectomy. Poel *et al.* reported a potency rate 53.3 %at 6 months after RALP, and 42% of patients had potency without using a PDE5 inhibitor. They concluded that prostatic fascia preservation resulted to good potency rates after RALP.18 Consequently, preservation of NVB and prostatic fascia is important to preserve erectile function. Di Pierro *et al.* compared potency rates between groups of patients treated with RRP and RALP. They performed RALP with a procedure using a transperitoneal approach and preserved the NVB through a tension- and energyfree technique19 as far as cancer localization allowed, and reported that the potency rate without PDE-5 inhibitors of the RALP group (68% and 55%) was significantly higher than

Pardo *et al.* reported that among patients with no relevant sexual problems at baseline, approximately 40% in the external and interstitial brachytherapy groups had preserved their

Merrick *et al.* reported that 39% of patients maintained potency after prostate brachytherapy with a plateau on the potency preservation curve at 6-year follow-up, and preservation of potency after brachytherapy correlated with preimplant erectile function, patients age, use of supplemental external beam radiation therapy, and diabetes, and was statistically

Asterling *et al.* reported that 3.7% and 14.3% of patients had partial erections at 6 weeks and 9 months after cryosurgical ablation. Besides, 21% and 24% of the patients had regained full

Hubosky *et al.* reported that cryotherapy patients experienced more negative impacts on

We reported that potency rates were 52%, 63% and 78% for patients who did not undergo NADT at 6, 12and 24 months after HIFU therapy. Furthermore, potency rates were 39%, 62% and 67% at 6, 12, and 24 months, respectively, after HIFUtherapy without the use of

sexual function steadily up to 12 months compared to brachytherapy patients.10

and residual urine volume recovered to baseline at 12, 24 months after HIFU.11

patients fared better and this was sustained up to 24 months.10

**4. Erectile function**

radiotherapy group.17

pretreatment sexual status.12

significant.20

are some times affected by tumor invasion.

**4.1 Erectile function after radical prostatectomy** 

that of the RRP group (25% and 26%) at 3 and 12 months after RALP.15

**4.2 Erectile function after radiation therapy, cryotherapy, and HIFU** 

potency at 18 and 24 months after cryosurgical ablation.21

comparable to baseline, but sexual domains remained well below baseline at 12 months follow-up and compared to brachytherapy, cryotherapy results in less irritative and obstructive voiding systems in the early post-treatment period, and may improve the urinary function for up to 24 months after treatment.10

We reported QOL after HIFU for localized prostate cancer.11 In our report the total FACT score significantly improved at 24 months, and Physical well-being factor(at 6 and 12 months after HIFU therapy) and Functionalwell-being factor (at 24 months after HIFU therapy) in FACT-G showed significant improvements. Further analysis of the elements of FACT-G showed such responses as "I am bothered by the side-effects of treatment" (at 12 months after HIFU therapy), "I am able to enjoy life" (at 24 months afterHIFU therapy) and "I have accepted my illness" (at 24 months after HIFU therapy) to have all statistically improved.
