Br J Cancer. 2013 May 14;108(9):1784-9. doi: 10.1038/bjc.2013.181.

Quality of life after prostate cancer treatments in patients comparable at baseline.

van Tol-Geerdink JJ, Leer JW, van Oort IM, van Lin EJ, Weijerman PC, Vergunst H, Witjes JA, Stalmeier PF.

Department of Radiation Oncology, Radboud University Medical Centre, PO Box 9101, Nijmegen, The Netherlands. J.vanTol@rther.umcn.nl

 

ABSTRACT

Background

Previous studies on the effects of different prostate cancer treatments on quality of life, were confounded because patients were not comparable. This study examined treatment effects in more comparable groups.

Methods

From 2008 to 2011, 240 patients with localised prostate cancer were selected to be eligible for both radical prostatectomy (RP) and external beam radiotherapy (EBRT). Brachytherapy (BT) was a third option for some. Health-related quality of life was measured by EPIC up to 12 months after treatment.

Results

In the sexual domain, RP led to worse summary scores (P<0.001) and more often resulted in a clinically relevant deterioration from baseline than BT and EBRT (79%, 33%, 34%, respectively). In the urinary domain, RP also led to worse summary scores (P=0.014), and more often deterioration from baseline (41%, 12%, 19%, respectively). Only on the irritative/obstructive urinary scale, more BT patients (40%) showed a relevant deterioration, compared to RP (17%) and EBRT (11 %). In the bowel domain, the treatment effects did not differ.

Conclusions

This study provides a more unbiased comparison of treatment effects, as men were comparable at baseline. Our results suggest that, for quality-of-life, radiotherapy is at least as good an option as RP for treating localised prostate cancer.

PMID: 23612450

 

SUPPLEMENT:

Many studies have reported differences in health-related quality of life associated with different treatments for prostate cancer; Radical prostatectomy was associated with more urinary incontinence and erectile dysfunction, whereas radiotherapy was associated with more irritative symptoms and bowel problems (1).

To date, however, this comparison has been confounded by the fact that the patients in the different treatment groups were not comparable. In most studies the surgery patients were younger, had less aggressive tumors and better pre-treatment functioning than the patients receiving external beam radiotherapy. This is problematic, because e.g. age at diagnosis and pre-treatment functioning are significant predictors of health related quality in all domains (2-4). Reducing the baseline differences between the patients yields a more unbiased comparison of the treatment effects.

In our study, radical prostatectomy (with nerve sparing procedure when possible), low dose brachytherapy (using seed implants) and external beam radiotherapy (with use of the endorectal balloon) were compared. By selecting patients to be eligible for both prostatectomy and radiotherapy, our study succeeded in creating treatment groups that were more comparable at baseline, and thus provided a more unbiased comparison of treatment effects. Examining the health-related quality of life in these groups yielded some interesting insights. Prostatectomy still led to more urinary incontinence and erectile dysfunction compared to radiotherapy, reflected in worse urinary and sexual summary scores (figures 1 and 2). However, the expected deterioration in bowel function after radiotherapy was not observed (figure 3).

Our findings suggest that in patients who have a choice between surgery and radiotherapy, the negative effects of external beam radiotherapy, when applied according to the latest techniques, e.g. with IMRT and rectal balloon, appear to be less pronounced than previously assumed.

JJ van Tol-Geerdink -Fig1Figure 1. Mean Urinary Summary scores over time after treatment (95% Confidence intervals). RP=Radical prostatectomy, BT=Brachytherapy, EBRT= External Beam Radiotherapy.

JJ van Tol-Geerdink -Fig2Figure 2. Mean Sexual Summary scores over time after treatment (95% Confidence intervals). RP=Radical prostatectomy, BT=Brachytherapy, EBRT= External Beam Radiotherapy.

JJ van Tol-Geerdink-fig3Figure 3. Mean Bowel Summary scores over time after treatment (95% Confidence intervals). RP=Radical prostatectomy, BT=Brachytherapy, EBRT= External Beam Radiotherapy.

 

References

1.         Penson DF. Quality of life after therapy for localized prostate cancer. Cancer J. 2007;13(5):318-26.

2.         Talcott JA, Manola J, Clark JA, Kaplan I, Beard CJ, Mitchell SP, et al. Time course and predictors of symptoms after primary prostate cancer therapy. J Clin Oncol. 2003;21(21):3979-86.

3.         Huang GJ, Sadetsky N, Penson DF. Health related quality of life for men treated for localized prostate cancer with long-term followup. J Urol. 2010;183(6):2206-12..

4.         Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 2000;283(3):354-60.

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