To conduct a prospective study to examine whether there are pre-treatment and post-treatment disparities in urinary, sexual, and bowel QOL by race/ethnicity, education, or income in men with clinically localized PCa.

Participants (N=1508; 81% White; 12% Black; 7% Hispanic; 50% surgery; 27% radiotherapy; 23% active surveillance) completed the Expanded Prostate Cancer Index Composite (EPIC-50) measure of PCa-specific QOL prior to treatment, 6 weeks, 6, 12, 18, and 24 months after treatment. We analyzed pre-treatment differences in QOL with multivariable linear regression and post-treatment differences with generalized estimating equation models.

Blacks and Hispanics (compared to Whites), and men with lower income had worse pretreatment urinary function; poorer and less educated men had worse pre-treatment sexual function (p<.05). In adjusted models, among men treated surgically, Blacks and Hispanics had worse bowel function compared to Whites and men with lower income experienced more sexual bother and slower recovery in urinary function. Not all racial/ethnic differences favored Whites; Blacks had higher sexual function than Whites prior to surgery and improved faster post-surgery. Blacks receiving radiotherapy had lower post-treatment bowel bother than Whites (p<.05).

Controlling for baseline QOL, there were some post-treatment disparities in urinary and sexual QOL that suggest the need to investigate whether treatment quality and access to follow-up care is equitable. However, survivorship disparities may, to a greater extent, reflect disadvantages in baseline health that exacerbate QOL issues after treatment.