Comparing Patient-Reported Urinary Symptoms after Prostate Radiation Therapy across Different Radiation Modalities

Abstract

<h3>Purpose/Objective(s)</h3> Comparative quality of life outcomes of different types of radiation therapy for prostate cancer have not been well studied. Herein we provide results comparing patient-reported urinary symptoms across four commonly used modalities: external beam radiotherapy (EBRT) using a moderately or conventionally fractionated course, brachytherapy, EBRT with a brachytherapy boost, and stereotactic body radiotherapy (SBRT). <h3>Materials/Methods</h3> As part of routine care at our institution, urinary and gastrointestinal symptoms are prospectively collected from patients receiving radiotherapy for prostate cancer using the validated Prostate Cancer Symptom Indices at each visit starting at consultation and continuing into follow-up. Patient-reported urinary symptoms including frequency, incontinence, dysuria, urgency, and nocturia were collected between 2006-2019. This included data from initial consult (baseline) and multiple follow-up time points. Data collected between 2-3 months after finishing radiotherapy was used for the 3-month time point. Similarly, data collected between 4-6, 10-12, and 19-24 months were used for the 6 month, 1 year, and 2 year time points. As validated in prior studies, a score of 3 or higher indicated clinically meaningful symptoms. <h3>Results</h3> 1059 patients reported urinary symptoms and were used for this analysis. 587 (55%) received EBRT alone, 144 (14%) received brachytherapy alone, 151 (14%) received EBRT with brachytherapy boost, and 177 (17%) were treated with SBRT. The percentage of patients reporting clinically meaningful symptoms was highest at baseline (59-89%) and lowest at 2 years (13-38%). For patients receiving EBRT alone and brachytherapy alone, most symptoms were found to peak 3-6 months after radiotherapy, with a slow decline thereafter. At two years for these modalities, symptoms were near or below baseline. These rates were generally higher for brachytherapy across all types of urinary symptoms. For patients treated with EBRT plus brachytherapy boost incontinence remained at or near baseline, frequency peaked at 3 months, and nocturia, urgency, and dysuria peaked at 1 year. For patients treated with SBRT all urinary symptoms saw a gradual increase from baseline after radiotherapy throughout the entire two-year study period. <h3>Conclusion</h3> From these data, we see that urinary symptom trajectory is distinct among radiation therapy modalities. These results support careful consideration of baseline urinary symptoms when discussing treatment recommendations.