Long‐term toxicity and quality of life up to 10 years after low‐dose rate brachytherapy for prostate cancer

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Prostate BXT is an established treatment option for low and intermediate risk localized prostate cancer. Long‐term studies have confirmed similar oncological outcomes for low risk disease compared with radical prostatectomy and external beam radiotherapy. This study reports long‐term toxicity for a large cohort of patients who had been followed‐up after LDR BXT for up to 10 years, with a minimum follow‐up of 5 years. Long‐term toxicity results are very encouraging and provide useful date to help clinicians and patients make informed treatment choices. OBJECTIVE To report on the long‐term toxicity outcome for patients with prostate cancer treated by low‐dose rate (LDR) brachytherapy (BXT). PATIENTS AND METHODS The study population comprised a cohort of men treated in our centre between March 1999 and April 2004 with LDR BXT for prostate cancer who had at least 5 years of follow‐up post‐implant. Patients who had died or experienced biochemical failure were excluded. We contacted eligible patients and asked them to complete a questionnaire to assess current urinary, erectile and bowel function. Urinary and erectile function was compared pre‐ and post‐treatment and outcomes were assessed by treatment modality. RESULTS Of the 226 LDR BXT‐treated patients with >5 years of follow‐up, 174 (77.0%) responded to the questionnaire. The mean International Prostate Symptom Score (IPSS) increased from 6.70 pre‐BXT to 7.91 at follow‐up (P= 0.003). Of the patients with mild symptoms pre‐BXT (IPSS, 0–7), 64.2% retained mild symptoms at follow‐up, 31.2% developed moderate symptoms (IPSS, 8–9) and 4.6% reported severe symptoms (IPSS, 20–35). A good or acceptable quality of life (QoL) secondary to urinary symptoms (IPSS QoL, 0–4) was reported by 98.0% of respondents. Of those patients potent (International Index of Erectile Function‐5 ≥11) pre‐BXT, 62.9% remained potent at follow‐up. There were no differences in the proportion of patients who were potent when analyzed by the number of years post‐implant. At follow‐up, 51.7% and 45.4% of patients, respectively, had normal or mild bowel symptoms as indicated by the European Organisation for the Research and Treatment of Cancer questionnaire (QLQ‐C30/PR25 scores, 4–8). Moderate bowel symptoms (QLQ‐C30/PR25 scores, 9–12) were reported by 2.9% of respondents; none reported severe symptoms. CONCLUSION The present study shows low morbidity after LDR BXT over the long‐term for a large cohort of patients.

Converting Data into Evidence

“…At the other extreme, only 0.9 % of hospitals perform as many as 166-170 RALPs. Emara et al (2011) employed graphic techniques to describe the effect of treatment on the primary study endpoint in their study. Their research evaluated the urinary and bowel symptoms, quality of life, and sexual function of men followed for 5-10 years after treatment with low-dose rate brachytherapy for prostate cancer at their cancer center.…”

Current Status of Brachytherapy for Prostate Cancer

“…Grade 2 and 3 or grade 4 rectal toxicity occurs in 2 to 12% and 0.4 to 2% of patients, respectively [31]. …”

“…In a report on long-term toxicity after LDR brachytherapy [33], patient quality of life and sexual function up to 10 years after prostate brachytherapy were analyzed. The results confirmed that brachytherapy had a favorable side effect profile over the long term with regard to potency and urinary and bowel toxicity.…”

Pelvic symptoms after radiotherapy in prostate cancer: a cross-sectional study

“…In addition to the physiological repercussions, post-RT pelvic symptoms may restrict daily living activities (DLA), social interactions, and self-perception of health. The greatest problems are related to social and mental well-being, which may have psychological, physical, professional, social, and sexual repercussions with a significant impact on QoL [9,10].…”