Quality of life following 3D conformal radiation therapy or permanent interstitial brachytherapy for localized prostate cancer

Abstract

Purpose: Both 3D Conformal Radiation Therapy (3DCRT) and Transperineal Interstitial Permanent Brachytherapy (TIPPB) are offered as suitable non-surgical alternatives to radical prostatectomy. Despite equivalent cancer control, very little data has been published that compares Quality of Life (QOL) in contemporary cohorts of patients choosing these treatments. Materials and Methods: Since 1998, patients selecting either 3DCRT alone or TIPPB (monotherapy or boost after external beam) for primary management of localized prostate cancer were asked to participate in a prospective assessment of QOL measures. In this preliminary report, 41 3DCRT and 40 TIPPB (34 monotherapy, 6 boost) patients completed validated QOL instruments at each followup visit. QOL instruments included the International Prostate Symptom Score (IPSS), FACT-P, and Sexual Adjustment Questionnaire (SAQ). Results: The average age of men in each group was 69 years. Choice of treatment was left to the patient unless there were significant medical or technical contraindications to either modality. 3DCRT total doses ranged from 61-78 Gy (mean 73.5Gy) and TIPPB doses were 145Gy (TG43) in 34 I-125 implants and 115 Gy in 1 Pd-103 (monotherapy) or 90 Gy in 5 Pd-103 (boost) implants. Patients undergoing TIPPB reported significantly worse urinary and sexual function than their counterparts receiving 3DCRT. The mean cumulative IPSS was 12.5 with TIPPB compared to 8.3 with 3DCRT (p=0.036). Differences were most pronounced in the first 12 months after treatment, particularly with respect to the strength of stream and the need to strain. TIPPB patients were more likely to report a need to urinate frequently (p=0.02), require a pad (p=0.001), be bothered (p=0.02), or have activity limited by urinary side effects (p=0.01). TIPPB patients were less likely to resume sexual activity within 6 months after treatment (p=0.0003) and engaged in sexual activity less often (p= 0.016) than 3DCRT patients. They were also more likely to express dissatisfaction with sex (p=0.009) and less willing to initiate sexual activity (p=0.02). TIPPB patients also reported a small, but significant increase frequency of trouble moving their bowels (p=0.018), and lack of energy (p=0.05). When differences occurred between the two groups, they were most dramatic in the first 6 to 9 months with some differences persisting for more than one year. Conclusion: Although both treatments are effective in the management of early stage prostate cancer, patients undergoing TIPPB have significantly more urinary, sexual, and bowel troubles than similar patients treated with 3DCRT.