Patient-reported outcomes using a validated LENT-SOMA questionnaire for post-prostatectomy radiotherapy.

Abstract

118 Background: Although local post-operative radiotherapy (RT) improves biochemical progression free survival, there is no evidence of overall survival benefit. With a trend for radical prostatectomy (RP) and radiotherapy for more advanced disease, the debate continues about the merits of multimodality treatment in these patients and the importance of survivorship. We assessed prospectively the effect of combination surgery and radiotherapy on the long term outcomes of patients. Methods: A validated LENT-SOMA (LS) questionnaire was posted to 238 UK patients treated from 2004 to 2009 with post-RP RT to assess patient-reported outcomes after prostate cancer treatment. Patients were treated with hypofractionated 3D conformal RT using image guidance delivering 52.5Gy in 20 fractions over 28 days to the prostate bed, but not to whole pelvis. LS responses were compared with patient perception of their bowel, bladder and sexual function post-RP. Results: Median follow up from RT was 6.26 years. Fifty five percent (130 out of 238) of patients returned questionnaires. Median maximum LS scores for bladder and bowel were three with over 75% of patients reporting at least one occasion of bowel or bladder difficulty in the past month. There was no difference in mean LS scores when compared pre and post RT. No patients had grade 3/4 RTOG toxicities. The median maximum LS score for sexual function was four. There was a significant difference in mean LS scores for sexual function (p=0.001) when compared pre and post radiotherapy. LS scores were not affected by post-RT hormones (26 out of 130 patients) or the time between RP and RT (median 1.76 years). Conclusions: The validated LS questionnaires revealed changes in sexual function post-RT compared with pre-RT were greater than bowel or bladder function. It remains difficult to determine the relative contributions of RP and RT to the late toxicity of multimodality treatment. Ongoing large multi-centre randomised control trials such as the UK-led RADICALS trial will answer questions about timing of RT and need for additional hormones. With the increasing importance of survivorship, it should be noted that prostate-specific antigen control at the expense of toxicity without an overall survival advantage should be treated with caution.