Assessment of 3-Year Follow-up on Genitourinary and Bowel Function Quality of Life (QOL) in Prostate Cancer Patients Receiving Radiation Therapy

Article Outline

• Purpose/Objective(s)
• Materials/Methods
• Results
• Conclusions
• Copyright

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Purpose/Objective(s) 

To determine QOL of patients receiving radiation therapy as primary treatment for newly diagnosed prostate cancer, through self-report. The patients received monotherapy via External Beam Radiation Therapy (EBRT), High Dose Rate (HDR) brachytherapy, or Palladium (Pd) implants.

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Materials/Methods 

Eligible patients are asked to complete the International Prostate Symptom Score (IPSS) and the Rectal Function Study Questionnaire-Schiffler Oncology Center at a pre-treatment baseline, completion of EBRT course or 2 weeks post-brachytherapy (fini), and 6 months, 1-, 2-, and 3-years post-fini. The International Index of Erectile Function (IIEF) is completed at these timepoints, less fini. 168 patients are currently at the 3-year time interval; 115 EBRT, 34 HDR, 19 PD. Of this population, 138 received androgen deprivation (ADT), 30 did not. Measures for overall QOL for each questionnaire were analyzed using repeated measures ANOVA based on Generalized Estimating Equations and Generalized Linear Mixed Models: total mean IPSS, or American Urological Association (AUA) score, final Rectal Function Study question (BMQOL), and mean IIEF score. Trends were analyzed for significance comparing treatment modalities, time, and use of hormones; p < 0.05 considered significant.

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Results 

No patient scored above 30 on IPSS, range 0-30. Patients that elected to undergo HDR had lower baseline mean AUA than EBRT, with highest scores in PD group. At fini, EBRT had lowest scores, followed by HDR. PD remained the highest. After 6 months, all AUA scores improved, were similar among 3 groups, and maintained lower than baseline. (all p < 0.0001) BMQOL was affected only by time, with results improving from fini, through 3-years post-treatment (p < 0.0001). ADT has no effect on urinary or bowel QOL (p = 0.6524 and p = 0.7558, respectively). Mean IIEF scores decreased through 1-year post-treatment, then stay near that low-point thereafter (p = 0.0086). HDR patients continue with higher IIEF scores over time, followed by EBRT, then PD with lowest scores. This trend is true for both ADT groups (p < 0.0001).

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Conclusions 

HDR patients have more acute urinary toxicity. All AUA scores improved post-radiation therapy. Bowel QOL also improved over time, regardless of treatment modality. Neither urinary nor bowel function were affected by use of androgen deprivation therapy. HDR patients had the best overall erectile function. IIEF scores declined through 1-year post-treatment for all groups and remained low through 3-years. Therefore, all patients show improvement in their treatment-related urinary and bowel toxicities, while erectile dysfunction becomes more pronounced following radiation therapy.