Quality of Life after Radiation Therapy for Prostate Cancer With a Hydrogel Spacer: Five Year Results

Abstract

Long-term clinical results are needed to better define a possible benefit of spacers for prostate cancer radiotherapy (RT). The aim of this analysis was to evaluate quality of life changes up to five years after radiotherapy for prostate cancer with a hydrogel spacer. In the years 2010-2011, 114 patients received external beam radiotherapy to the prostate. Fifty-four patients were selected for a hydrogel injection before the beginning of RT. Treatment was performed with a five-field IMRT technique with daily ultrasound based image guidance, applying fractions of 2 Gy up to a total dose of 76 Gy (n = 96) or 78 Gy (n = 18, all with hydrogel). Patients were surveyed prospectively before RT, at the last day of RT, a median time of 2 months, 17 months and 63 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite; comprising 50 items concerning urinary, bowel, sexual and hormonal domains). The multi-item scale scores were transformed linearly to a 0-100 scale, with higher scores representing better QOL. A mean score change of >5 points is defines as clinically relevant. Mean bowel function and bother score changes of >5 points in comparison to baseline levels before treatment were found only at the end of RT (10-15 points; P < 0.01) for patients treated with a hydrogel spacer. Mean long-term urinary and bowel domain scores did hardy differ from baseline levels (<2 points). Not a single patient reported about a moderate or big problem with his bowel problems overall (see Table 1).Abstract 1083; Table 1With spacer(n = 54)Without spacer(n = 60)P-valueMean (quartiles) urinary bother score change1 year after RT-2 (-7;0;4)-3 (-11;-4;4)0.49Mean (quartiles) bowel bother score change-1 (0; 0; 0)7 (-4;0;14)0.13Moderate/big problem with bowel urgency0%13%<0.01Moderate/big problem with bowel habits overall0%17%<0.01Mean (quartiles) urinary bother score change5 years after RT0 (-5;0;7)-3 (-9;-4;4)0.22Mean (quartiles) bowel bother score change1 (0;0;4)6 (-4;0;11)0.99Moderate/big problem with bowel urgency0%14%0.01Moderate/big problem with bowel habits overall0%7%0.08 Open table in a new tab Baseline patient characteristics were similar to patients who were treated without a spacer in the same time period (median age of 73 years in both groups, median prostate volume of 56cc with vs. 62cc without a spacer). Bowel domain score changes were higher (statistically not significant) in comparison to the patient group with a spacer, with mean bother score changes of 21 points at the end of RT, 8 points at two months, 7 points at 17 months and 6 points at 63 months after RT. A bowel bother score change >10 points was found in 6% vs. 32% (P<0.01) at 17 months and in 5% vs. 14% (P = 0.2) at 63 months with vs. without a spacer. The first five-year quality of life results in a group of prostate cancer patients treated with a hydrogel spacer demonstrate excellent treatment tolerability, in particular regarding bowel problems. Further studies with dose-escalated or re-irradiation concepts can be encouraged.