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

Abstract

Purpose 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.

Health‐related quality of life, psychosocial functioning, and unmet health needs in patients with sarcoma: A systematic review

“…Patients with sarcoma were reported to have lower outcomes at all disease phases compared with the general population, despite showing improvements in HRQoL during follow‐up. This is similar to results noted for other malignancies . Patients treated for sarcoma typically reported issues with their role and social functioning, as well as fatigue, insomnia, pain, loss of appetite, anxiety, and depression.…”

“…This is similar to results noted for other malignancies. [61][62][63] Patients treated for sarcoma typically reported issues with their role and social functioning, as well as fatigue, insomnia, pain, loss of appetite, anxiety, and depression.…”

Quality of life after brachytherapy or bilateral nerve‐sparing robot‐assisted radical prostatectomy for prostate cancer: a prospective cohort

“…Most analyses on QoL after brachytherapy are non‐comparative and therefore have limited value in counselling patients other than by identifying factors associated with toxicity which can be minimized . Other relevant comparisons of brachytherapy and surgery have confirmed the clinically relevant impact of surgery on sexual dysfunction and urinary continence while brachytherapy typically increased urinary irritation/obstruction .…”

Health‐related quality of life outcomes from a contemporary prostate cancer registry in a large diverse population

“…Some authors have achieved long longitudinal follow‐up of selected cohorts, such as patients who undergo EBRT compared to BT , and surgery compared to surgery with adjuvant radiation . In two of the longest follow‐up of functional outcomes studies to date, comparisons were made only between ORP and EBRT and surgery vs EBRT and BT .…”