ArticleProstate cancer and prostatic diseases2026
Quality of life in low-risk prostate cancer under active surveillance or following radical treatments: the START cohort study.
Article in Prostate cancer and prostatic diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Natural history of untreated prostate cancer: a comprehensive review of long-term progression patterns and survival outcomes.Prostate cancer and prostatic diseases · 2026Pooled it
- Active Surveillance for Low- and Favourable Intermediate-Risk Prostate Cancer: A Single-Centre Cohort Study on Discontinuation Rates and Quality-of-Life Outcomes.Journal of personalized medicine · 2026Article
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54 authors.
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Abstract
backgroundReal-world evidence on quality of life (QoL) changes associated with treatment decisions is crucial for informed choices by patients with low-risk prostate cancer (LRPC).
methodsA prospective cohort study was conducted in the Piemonte and Valle d'Aosta Regional Oncology Network, NW Italy (4.5 million population), including nearly all urology (N = 22) and radiation oncology (N = 6) centres. Patients newly diagnosed with LRPC, eligible for radical treatments, received balanced information on risks and benefits of available options and could choose among active surveillance (AS), radical prostatectomy (RP), or radiotherapy (RT). Longitudinal changes in QoL were assessed via patient-reported outcomes in four domains: general QoL, mental health, sexual function and urinary/bowel symptoms. The main comparison was between AS and RP. A secondary comparison was between AS and all radical treatments (RP or RT). Data were analysed by multivariable generalised linear or logistic models, following the intention-to-treat principle and accounting for correlation within centres and subjects.
resultsA total of 651 patients (76.4% of those enrolled, 559 in AS, 76 in RP and 16 in RT) with baseline questionnaires were included (median [IQR] age, 70 [64-74] years). During a median follow-up of 37 months, no differences in general QoL or mental health were observed between AS and RP. Men in AS had better scores for sexual function (β = 8.27, 95% CI: 5.57-10.96) and activity (β = 6.70, 95% CI: 4.19-9.20). Use of incontinence aids was significantly lower in the AS group (OR = 0.14; 95% CI: 0.09-0.23). Prostatic obstructive symptoms remained stable in AS but decreased in the RP group (OR = 2.77; 95% CI: 1.52-5.06). Results were similar comparing AS to RP or RT.
conclusionsCompared to radical prostatectomy, AS preserved urinary continence and sexual function but was associated with persistent obstructive symptoms, without differences in general QoL or mental health. This real-world study supports existing evidence, aiding LRPC patients in making informed decisions.
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