Abstract
Background and Purpose: Worsening lower urinary tract symptoms (LUTS) are a frequent adverse event following proton beam therapy (PBT) for localized prostate cancer. We investigated the differences in worsening LUTS among patients who received PBT at different times of day. Participants and Methods: Among 173 patients who underwent PBT for prostate cancer, 168 patients (median age 68.5 years) completed international prostate symptom score (IPSS) questionnaires and were included. Changes in the IPSS from baseline to the end of PBT were assessed by multiple linear regression analysis for age, National Comprehensive Cancer Network risk classification, androgen deprivation therapy, fractional PBT dose, clinical target volume, severity of IPSS, diabetes, LUTS medication use before PBT, anti-coagulant therapy and radiation time of day (morning (08:30–10:30), around noon (10:31–14:30), and late afternoon (14:31–16:30)). Results: IPSS total score and IPSS-Quality of Life (QoL) score (12 patients were excluded due to missing IPSS-QoL score) increased from eight to 14.9 (p < 0.0001) and from two to four (p < 0.0001), respectively. Time of day (morning) was the only determinant for worsening LUTS (β = −0.24, p < 0.01), voiding subscore (β = −0.22, p < 0.05) and IPSS-QoL (β = −0.27, p < 0.005), and was a determinant in item four (urgency) (β = −0.28, p < 0.005) with age (β = 0.19, p < 0.05). Conclusions: Morning PBT for localized prostate cancer significantly ameliorated worsening LUTS and improved QoL compared with treatment around noon or late afternoon. Chronoradiation therapy for localized prostate cancer may be effective and further research to elucidate the underlying mechanism is warranted.
Highlights
Proton beam therapy (PBT) is a promising curative therapy for localized prostate cancer as well as surgical resection and other radiation therapies (RTs) such as intensity-modulated radiation therapy and heavy particle therapy [1]
We show that lower urinary tract symptoms (LUTS) caused by proton beam therapy (PBT) for localized prostate cancer may be influenced by time of day of treatment
There was no significant difference in initial prostate-specific antigen (PSA) level, Gleason score, clinical tumor stage, National Comprehensive Cancer Network (NCCN) risk classification, androgen deprivation therapy (ADT), fractional PBT dose, clinical target volume (CTV), international prostate symptom score (IPSS) total score, severity of IPSS, LUTS medication use before PBT, diabetes, or anti-coagulant therapy among these three groups (Table 1)
Summary
Proton beam therapy (PBT) is a promising curative therapy for localized prostate cancer as well as surgical resection and other radiation therapies (RTs) such as intensity-modulated radiation therapy and heavy particle therapy [1]. One of the relatively frequent adverse events following PBT treatment is lower urinary tract symptoms (LUTS). This significantly decreases the Quality of Life (QoL) of the patients. Worsening lower urinary tract symptoms (LUTS) are a frequent adverse event following proton beam therapy (PBT) for localized prostate cancer. Changes in the IPSS from baseline to the end of PBT were assessed by multiple linear regression analysis for age, National Comprehensive Cancer Network risk classification, androgen deprivation therapy, fractional PBT dose, clinical target volume, severity of IPSS, diabetes, LUTS medication use before PBT, anti-coagulant therapy and radiation time of day (morning (08:30–10:30), around noon (10:31–14:30), and late afternoon (14:31–16:30)). Conclusions: Morning PBT for localized prostate cancer significantly ameliorated worsening LUTS and improved QoL compared with treatment around noon or late afternoon. Chronoradiation therapy for localized prostate cancer may be effective and further research to elucidate the underlying mechanism is warranted
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