Quality of life more than 10 years after radiotherapy for localized prostate cancer—impact of time after treatment and prescription dose

Abstract

Purpose Analysis of quality of life changes after radiotherapy with focus on the impact of time after treatment and prescription dose. Methods Consecutive patients were treated with doses from 70.2/1.8 Gy (n = 206) to 72/1.8–2.0 Gy (n = 176) in a single centre and surveyed using the Expanded Prostate Cancer Index Composite questionnaire. Results Urinary and bowel bother scores decreased 1 / 3 / 6 points and 7 / 7 / 9 points on average 1 / 5 / 10 years after RT in comparison to baseline scores. The rate of urinary (need of pads in 8% vs. 15% before vs. 10 years after RT; p = 0.01) and bowel (uncontrolled leakage of stool in 5% vs. 12% before vs. 10 years after RT; p < 0.01) incontinence, as well as rectal bleeding (4% vs. 8% before vs. 10 years after RT; p = 0.05) increased. Sexual function scores decreased (erections sufficient for intercourse in 36% vs. 12% before vs. 10 years after RT; p < 0.01). A higher dose had a statistically significant impact on urinary bother and stool incontinence, but also tended to decrease urinary continence. Age and comorbidities did not have an influence on score changes, but on baseline urinary function/bother and baseline sexual function. Conclusion Apart from an increasing rate of erectile dysfunction, urinary and bowel incontinence rates increased with increasing follow-up period. A higher dose was found to be associated with increased urinary problems and larger stool incontinence rates. Age and comorbidities were found to be relevant for baseline scores, but not for score changes.

Late Adverse Health Outcomes and Quality of Life after curative radiotherapy + long-term ADT in Prostate Cancer Survivors: Comparison with men from the general population

“…This approach increases the understanding of the associations between PCaSs' QoL and the specific AHOs. Our data thus indicate that the stepwise reduction of urinary bowel and problems increases QoL in PCaSs and Norms, As also discussed by others (2,(4)(5)(6) for the sexual domain this association was in our PCaSs only moderate or weak: Only about two thirds of our PCaSs reporting substantial erectile dysfunction also described big or moderate sexual function problems. We can only speculate about an explanation of the limited association between sexual problems and QoL in PCaSs.…”

“…Typical post-RT AHOs have in PCa survivors (PCaSs) been described in multiple studies [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] but few reports, often from non-European institutions, have dealt with PCaSs living for more than five years after RT (“Long-term PCaSs”) [2] , [3] , [4] , [5] , [8] , [9] , [10] , [11] . Moreover, the numbers of evaluated long.term PCaSs have often been limited (<200).…”

Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion – A Narrative Review

“…Following a study by Pinkawa et al ( 97 ), radiation therapy-induced urinary incontinence (defined as usage of pads) ranges between 8 and 15% after 5 years of follow up. Due to different radiation therapy modalities, radiation dosage and differing follow-up periods, issuing a precise statement regarding incidence rates of urinary incontinence following radiation therapy, is difficult ( 98 ).…”

Gastrointestinal Quality-of-Life Trajectories after Radiotherapy for Prostate Cancer—Which Patients Suffer from Persisting Problems?

“…A stable period in the second year after treatment does not guarantee stability over many years. Regarding chronic radiation-associated toxicity, far longer time periods need to be considered so that studies ensuring a longer follow-up of five and more years after treatment can be supported [18]. To understand rectal toxicity, it is crucial to understand predisposing factors in order to be aware of patients at greater risk and to understand the different trajectories that have been described, particularly the association with acute toxicity but also an independent development of toxicity over many years.…”