Abstract
BackgroundAs the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument.MethodsPatients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL.ResultsThe largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients.ConclusionsOverall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.
Highlights
As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions
Consistent with other findings, this study demonstrated radical prostatectomy was associated with urinary incontinence and sexual dysfunction whereas the radiation treatments were associated with short-term decrements in bowel QOL and gradual sexual QOL declines
It is in this context that we present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument (EPIC)
Summary
As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. Technical advances have added additional treatment options such significantly different in low-risk patients undergoing prostatectomy or active surveillance, prostatectomy may reduce mortality in patients with higher PSA scores or intermediate- and high-risk cancer. In this setting, factors such as the invasiveness and length of treatment, treatment-related toxicity, and the impact of treatment on quality of life (QOL), play increasingly important roles in the treatment decision process. Pardo et al published a longitudinal, comparative QOL study using the validated Expanded Prostate Cancer Index Composite (EPIC) QOL instrument for patients receiving surgery, externalbeam radiation therapy or brachytherapy but who did not receive hormonal therapy [16]. Consistent with other findings, this study demonstrated radical prostatectomy was associated with urinary incontinence and sexual dysfunction whereas the radiation treatments were associated with short-term decrements in bowel QOL and gradual sexual QOL declines
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
