Longitudinal assessment of quality of life after surgery, conformal brachytherapy, and intensity-modulated radiation therapy for prostate cancer

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• 作者：Michael J. Zelefsky^a ; ^{zelefskm@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Bing Ying Poon^b ; James Eastham^c ; Andrew Vickers^b ; Xin Pei^a ; Peter T. Scardino^c
• 关键词：ADT ; androgen-deprivation therapy ; CI ; confidence interval ; EBRT ; external beam ; IIEF-6 ; International Index of Erectile Function ; IMRT ; intensity-modulated radiotherapy ; PSA ; prostate-specific antigen ; QoL ; quality of life ; RP ; radical prostatectomy ; SD ; standard deviation
• 刊名：Radiotherapy and Oncology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：118
• 期：1
• 页码：85-91
• 全文大小：851 K

文摘

We evaluated quality-of-life changes (QoL) in 907 patients treated with either radical prostatectomy (open or laparoscopic), real-time planned conformal brachytherapy, or high-dose intensity-modulated radiotherapy (IMRT) on a prospective IRB-approved longitudinal study.

Methods

Validated questionnaires given pretreatment (baseline) and at 3, 6, 9, 12, 15, 18, 24, 36, and 48 months addressed urinary function, urinary bother, bowel function, bowel bother, sexual function, and sexual bother.

Results

At 48 months, surgery had significantly higher urinary incontinence than others (both P < .001), but fewer urinary irritation/obstruction symptoms (all P < .001). Very low levels of bowel dysfunction were observed and only small subsets in each group showed rectal bleeding. Brachytherapy and IMRT showed better sexual function than surgery accounting for baseline function and other factors (delta 14.29 of 100, 95% CI, 8.57–20.01; and delta 10.5, 95% CI, 3.78–17.88). Sexual bother was similar. Four-year outcomes showed persistent urinary incontinence for surgery with more obstructive urinary symptoms for radiotherapy. Using modern radiotherapy delivery, bowel function deterioration is less-often observed. Sexual function was strongly affected in all groups yet significantly less for radiotherapy.

Conclusions

Treatment selection should include patient preferences and balance predicted disease-free survival over a projected time vs potential impairment of QoL important for the patient.