Worse Bowel Function Research Articles

Patient-reported Outcomes After External Beam Radiotherapy With Low Dose Rate Brachytherapy Boost vs Radical Prostatectomy for Localized Prostate Cancer: Five-year Results From a Prospective Comparative Effectiveness Study.

Data comparing radical prostatectomy and external beam radiation therapy with low dose rate brachytherapy boost are lacking. To better guide shared decision making regarding treatment, we compared patient reported outcomes through 5 years following radical prostatectomy or external beam radiation therapy with low dose rate brachytherapy boost for localized prostate cancer. From 2011-2012, men aged <80 years with localized prostate adenocarcinoma were enrolled and followed longitudinally. Patient reported outcomes included the Expanded Prostate Index Composite. Regression models adjusted for baseline scores and covariates were constructed. The study population included 112 men treated with external beam radiation therapy with low dose rate brachytherapy boost and 1,553 treated with radical prostatectomy. Compared to radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was associated with clinically meaningful worse urinary irritative/obstructive (adjusted mean score difference [95% confidence interval]: 5.0 [-8.7, -1.3]; P = .008 at 5 years) and better urinary incontinence function (13.3 [7.7, 18.9]; P < .001 at 5 years) through 5 years. Urinary function bother was similar between groups (P > .4 at all timepoints). Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with worse bowel function (-4.0 [-6.9, -1.1]; P = .006 at 5 years) through 5 years compared to radical prostatectomy. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with better sexual function at 1 year (12.0 [6.5, 17.5]; P < .001 at 1 year) compared to radical prostatectomy, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years. Compared to radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was associated with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment. These patient-reported functional outcomes may clarify treatment expectations and help inform treatment choices for localized prostate cancer.

Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study).

ObjectiveTo investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision‐making.Patients and MethodsMen aged 50–69 years diagnosed with localised prostate cancer by prostate‐specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external‐beam radiotherapy (EBRT) with concurrent androgen‐deprivation therapy (ADT) and 77 low‐dose‐rate brachytherapy (BT, not a randomised treatment). Patient‐reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores.ResultsTreatment‐received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL.ConclusionTreatment decision‐making for localised prostate cancer can be informed by these 6‐year functional and QoL outcomes.

Restorative reconstruction after total mesorectal excision for rectal cancer is associated with significant bowel dysfunction from initial presentation

BackgroundPatients often desire restorative reconstruction following total mesorectal excision. Reconstruction has become synonymous with providing high-quality rectal cancer care. However, the bowel functional outcomes of restoration from presentation are unknown. We aimed to evaluate the bowel functional effects of rectal cancer treatment from presentation through surveillance. MethodsThis was a retrospective cohort study from 2014 to 2019 using prospectively collected data. Patients underwent treatment for rectal adenocarcinoma including restorative reconstruction. Patients completed the validated Colorectal Functional Outcome questionnaire during clinic visits (1) at presentation, (2) after neoadjuvant therapy, (3) after restoration of continuity, and (4) at surveillance. Scores range from 0 to 100 with a higher score indicating worse bowel function. ResultsSixty-eight patients (age: 62 ± 12 years, 40% female) were included. The mean tumor height was 7 ± 4 cm with 85% symptomatic. Bowel function did not worsen from presentation to after neoadjuvant therapy in Total Colorectal Functional Outcome and most domain scores; there was improvement in frequency and stool-related aspects. Bowel function worsened in all scores from after neoadjuvant to restoration of continuity (mean anastomotic height: 5 ± 2 cm); there were similar findings between presentation and restoration of continuity. At surveillance, there was improvement in most domains compared with restoration of continuity. There remained significant worsening of incontinence, social impact, and need for medication scores at surveillance compared with presentation. ConclusionRestorative reconstruction after total mesorectal excision is associated with significant bowel dysfunction. For some patients, restorative reconstruction may not be high-quality rectal cancer care.

Analysis of morbidity and mortality, quality of life and bowel function after total colectomy with ileorectal anastomosis versus right and left hemicolectomy: A study to optimise the treatment of lynch syndrome and attenuated polyposis coli

BackgroundThe optimal surgical treatment for colonic colorectal carcinoma (CRC) in Lynch Syndrome (LS) and attenuated polyposis coli (A-FAP phenotype) patients is still debated, since there is a high risk of metachronous colonic adenomas and carcinoma after primary surgery. The aim of this study was to compare surgical outcome, functional data, and Quality of Life (QoL) after total colectomy with ileorectal anastomosis (TC-IRA) compared to right (RH) or left hemicolectomy/sigmoidectomy (LH/SI). MethodsPatients who underwent TC-IRA (ileorectal anastomosis from 8 to 15 cm from the anal verge) for CRC and/or polyposis at our Surgical Department between 2001 and 2017 were included in the study group, and were matched one-to-one by baseline and clinical characteristics with a control group of RH and LH/SI. Morbidity and mortality data were collected (Clavien-Dindo classification). International validated questionnaires were used to investigate QoL and bowel function. ResultsFifty-five patients were enrolled in each group. No differences were found on length of hospital stay, Clavien-Dindo grade III-IV complications and mortality (p > 0.05). TC-IRA showed a longer operative time than RH and LH/SI (p < 0.0001) and a major blood loss than RH (p < 0.0001). Worse bowel function and worse QoL, only for the bowel-related items, were recorded in TC-IRA group. The general QoL was similar among the groups. ConclusionsTC-IRA and segmental resection have similar morbidity and mortality. The worse bowel function in TC-IRA group does not impact on the general QoL. These data can be useful in the setting of risk-reducing surgery decision in LS and A-FAP patients.

Current status of research on short-term quality of life after sphincteric-saving surgery in rectal cancer patients

Sphincteric-saving surgery (SSS) is currently a hot spot in the treatment of mid-low rectal cancer. Although it preserves the anatomical continuity of the colon and anus, the postoperative functional outcomes and quality of life (QOL) remains to be confirmed. Current studies have shown that quality of life worsens at the first month after surgery, improves within 3-6 months, and stabilizes at about 1 year. The QOL was associated with patient-related factors, tumor-related factors, treatment-related factors and postoperative complications. For patient-related factors, younger patients have worse role function and sexual function but better cognitive function and physical function. Male patients deteriorate significantly in sexual and social function. For tumor-related factors, patients with lower rectal cancer have poorer defecation function. Those with advanced rectal cancer are more likely to suffer from side-effects related to chemotherapy. For treatment-related factors, patients undergoing intersphincteric resection have worse role function, body image and sexual interest. Preventive ileostomy results in the deterioration of role function, body image and sexual interest. Chemotherapy causes taste changes and chest pain. For postoperative complication, patients with anastomotic leakage have worse bowel function and psychological state. Patients with major low anterior resection syndrome and genitourinary dysfunction have worse global health score, social function and role function. In conclusion, short-term quality of life after sphincteric-saving surgery is acceptable. To improve QOL, specific intervention and guidance should be given to patients in this stage. Meanwhile, since many factors influence the quality of life simultaneously, researchers are confused about the questionnaire outcomes. Therefore, more specific and comprehensive tools are needed to evaluate QQL after sphincteric-saving surgery.

A prospective study of psychological distress after prostate cancer surgery.

Men treated for prostate cancer experience heightened psychological distress and have an increased risk of suicide. Management of this distress and risk is crucial for quality urological care. To identify risk indicators for poorer trajectories of psychological adjustment and health-related quality of life (QoL) after surgery for localised prostate cancer. Patients were newly diagnosed with localised prostate cancer scheduled for surgical treatment. Patients were assessed at baseline (pre-surgery) and 6 weeks, 3 months, 6 months, 12 months, and 24 months post-surgery. Assessment measures included sociodemographics, domain-specific and health-related QoL, and psychological distress. Mixed effects regression models were used to analyse the data. A total of 233 patients provided data for this analysis (Mage = 60 years, standard deviation [SD] = 4.02; MPSA = 7.37 ng/mL). At baseline, the prevalence of high psychological distress was 28% reducing to 21% at 24 months. Before treatment, younger age, more comorbidities, and worse bowel function were related to greater psychological distress; and younger age and better urinary, sexual, and bowel function were related to better health-related QoL. By contrast, for changes over time, only bowel function was important with better bowel function predicting decreasing psychological distress for men. Regular distress screening is indicated over the 24 months after surgery for localised prostate cancer. Care pathways for men with prostate cancer need also to respond to age-specific concerns and health problems associated with comorbidities in aging men. Focussed symptom control for bowel bother should be a priority.

Functional outcome, quality of life, and ‘failures’ following pull-through surgery for hirschsprung's disease: A review of practice at a single-center

AimsThe purpose of this study was to assess bowel function and quality of life (QoL) in patients with Hirschsprung's disease (HD) and identify patients who have ‘failed’ treatment. MethodsA review of a single-center HD cohort treated with pull-through surgery from 2004 to 2017 was completed. Bowel function of patients five years and above and QoL of all patients were assessed using validated questionnaires. Patients who ‘failed’ treatment were defined as above five years with one or more of: a) long-term stoma, b) needing an antegrade continence enema or transanal irrigation, c) severe soiling, or d) severe constipation. Statistical analysis was performed with P < 0.05 deemed significant. Data are given as mean [range]. ResultsSeventy-one patients presented with HD within the study period. Mean follow-up was 5.4 years [0.7–13.3]. Of 38 eligible patients, bowel function was assessed in 24 patients (nine had a stoma, five lost to follow-up). The mean incontinence score was 17 [0–28)], and the mean constipation score was 17 [5–25]. Incontinence and constipation scores were worse than healthy controls (P < 0.001 and P = 0.001, respectively) and did not improve with age. Fifty-six patients had QoL assessed with no difference between our cohort (81 [25–100]) and healthy controls (81 [unknown]); (P = 0.85). Thirty-three patients were assessed for ‘failure’ (bowel function score n = 24; stoma n = 9). Thirty of 33 (91%) children older than five years can be considered to have ‘failed’ treatment. ConclusionsPatients have worse bowel function than healthy children, which does not improve with age. QoL is comparable to healthy controls. A significant proportion of patients have poor outcomes and have ‘failed’ treatment. Level of evidenceLevel III.

Can the POLARS tool accurately predict low anterior resection syndrome in rectal cancer patients undergoing laparoscopic resection?

Radical rectal cancer resection can lead to a long-term bowel function impairment known as low anterior resection syndrome (LARS). It remains unclear how to determine which patients are at a higher risk of developing LARS post-surgery. The POLARS tool was designed to predict the onset and severity of LARS in rectal cancer patients after surgery. The study aimed to assess the accuracy of POLARS in predicting the onset of LARS. A total of 66 rectal cancer patients treated laparoscopically between January 2016 and December 2017 were included in this retrospective study. Using POLARS, the predictive value for the occurrence of LARS was documented. During an average 17-month follow-up period, the bowel function of the patients was assessed using the dedicated LARS questionnaire. The predicted and actual scores were then compared. Study participants included 36 women (54.5%) and 30 men (45.5%), with a mean age of 62.55 years (standard deviation: 10.2; range: 37-81). The mean predicted score according to POLARS was 24.5 (i.e. category "minor LARS"), and the mean actual score in the follow-up period was 16.42 ("no LARS" category). In only 39% of patients, the predicted LARS category was the same as the actual LARS category assessed by the questionnaire. Worse bowel function than reported at follow-up was predicted in 75% of all mispredictions. POLARS did not prove to be accurate in predicting the risk and severity of LARS in these patients, although the average numbers appear promising. Further evaluation of the POLARS tool using a larger cohort is needed.

Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines

J. Balmana1, F. Balaguer2, A. Cervantes3 & D. Arnold4, on behalf of the ESMO Guidelines Working Group* Department of Medical Oncology, Hospital Vall d’Hebron, Vall d’Hebron Institute of Oncology (VHIO), Universitat Autonoma de Barcelona, Barcelona; Department of Gastroenterology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; Department of Medical Oncology, Tumor Biology Clinic, Albert Ludwigs University, Freiburg, Germany;

Assessment of long-term rectal function in patients who received pelvic radiotherapy: a pooled North Central Cancer Treatment Group trial analysis, N09C1

Pelvic radiotherapy (PRT) is known to adversely affect bowel function (BF) and patient well-being. This study characterized long-term BF and evaluated quality of life (QOL) in patients receiving PRT. Data from 252 patients were compiled from two North Central Cancer Treatment Group prospective studies, which included assessment of BF and QOL by the BF questionnaire (BFQ) and Uniscale QOL at baseline and 12 and 24 months after completion of radiotherapy. BFQ scores (sum of symptoms), Uniscale results, adverse-event incidence, and baseline demographic data were compared via t test, χ (2), Fisher exact, Wilcoxon, and correlation methodologies. The total BFQ score was higher than baseline at 12 and 24 months (P < 0.001). More patients had five or more symptoms at 12 months (13 %) and 24 months (10 %) than at baseline (2 %). Symptoms occurring in greater than 20 % of patients at 12 and 24 months were clustering, stool-gas confusion, and urgency. Factors associated with worse BF were female sex, rectal or gynecologic primary tumors, prior anterior resection of the rectum, and 5-fluorouracil chemotherapy. Patients experiencing grade 2 or higher acute toxicity had worse 24-month BF (P values, <.001-.02). Uniscale QOL was not significantly different from baseline at 12 or 24 months, despite worse BFQ scores. PRT was associated with worse long-term BF. Worse BFQ score was not associated with poorer QOL. Further research to characterize the subset of patients at risk of significant decline in BF is warranted.

PWE-001 The Impact of Colonic Resection for Neoplasia on Functional outcomes and Related Quality of Life: a Case-Controlled Study

Introduction AimFunctional outcomes after elective colectomy (right, left or sigmoid) for neoplasia are poorly reported in the literature. This study evaluates bowel function and related quality of life in patients...

1471 QUALITY OF LIFE OUTCOMES AMONGST MEN UNDERGOING CONTEMPORARY TECHNIQUES FOR THE TREATMENT OF LOCALISED PROSTATE CANCER: A PROSPECTIVE STUDY

You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 20121471 QUALITY OF LIFE OUTCOMES AMONGST MEN UNDERGOING CONTEMPORARY TECHNIQUES FOR THE TREATMENT OF LOCALISED PROSTATE CANCER: A PROSPECTIVE STUDY Samarth Chopra, Ruban Thanigasalam, Kieran Beattie, Sam Egger, David Smith, James Symons, Anne-Maree Haynes, Richard Savdie, Phillip Brenner, Rob Sutherland, Krishan Rasiah, and Phillip Stricker Samarth ChopraSamarth Chopra Sydney, Australia More articles by this author , Ruban ThanigasalamRuban Thanigasalam Sydney, Australia More articles by this author , Kieran BeattieKieran Beattie Sydney, Australia More articles by this author , Sam EggerSam Egger Sydney, Australia More articles by this author , David SmithDavid Smith Sydney, Australia More articles by this author , James SymonsJames Symons Sydney, Australia More articles by this author , Anne-Maree HaynesAnne-Maree Haynes Sydney, Australia More articles by this author , Richard SavdieRichard Savdie Sydney, Australia More articles by this author , Phillip BrennerPhillip Brenner Sydney, Australia More articles by this author , Rob SutherlandRob Sutherland Sydney, Australia More articles by this author , Krishan RasiahKrishan Rasiah Sydney, Australia More articles by this author , and Phillip StrickerPhillip Stricker Sydney, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1992AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Monotherapy for localised prostate cancer with radical prostatectomy, external beam radiotherapy or brachytherapy produce similar oncological outcomes. Hence there is increasing need to evaluate and communicate the quality of life outcomes of these treatments. The aim of our prospective study was to determine how the various types of radical treatment at a tertiary referral centre affected the health related quality of life (HRQOL) domains of urinary, sexual, bowel, and hormonal features relative to men managed with active surveillance. METHODS We measured HRQOL outcomes from baseline through to 24 months after treatment using the EPIC questionnaire (Expanded Prostate Cancer Index Composite) in a cohort of 851 patients first treated for stage T1 or T2 prostate cancer from May 2007 to February 2011. Patients elected one of five management options: (1) Robotic prostatectomy (RALP) further subdivided by surgeon experience1 (1a) RALP <200 and (1b) RALP 200+; (2) Radical retropubic prostatectomy (ORP); (3) High dose rate brachytherapy (HDR); (4) Low dose rate brachytherapy (LDR) and (5) active surveillance (AS). Demographic and treatment variables were recorded at baseline. We used multivariate linear regression analyses with generalised estimating equations (GEE) to estimate adjusted mean differences in outcome scores between treatments. RESULTS A total of 770 (96%) men with complete data were included in the analysis. All baseline clinical and demographic characteristics showed significant heterogeneity within treatment types (P<0.001). Questionnaire completion rates ranged from 88% to 100% for any given treatment/month. There was a significant change in sexual quality of life in each group (P<0.005) from baseline to follow-up except in the AS group. Men in the RALP 200+ showed a significant trend towards return to baseline urinary and sexual function. Men in the HDR or LDR brachytherapy groups had worse bowel function and urinary irritation/obstructive scores after treatment but these scores improved between 12-24months. CONCLUSIONS Treatment for localised prostate cancer has significant and persistent adverse effects on quality of life. However, men managed by active surveillance maintained a reasonably stable quality of life scores across all EPIC domains. In the absence of randomized clinical trials, observational studies such as ours can help portray a realistic expectation in terms of changes in quality of life for men treated for localised prostate cancer. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e596-e597 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samarth Chopra Sydney, Australia More articles by this author Ruban Thanigasalam Sydney, Australia More articles by this author Kieran Beattie Sydney, Australia More articles by this author Sam Egger Sydney, Australia More articles by this author David Smith Sydney, Australia More articles by this author James Symons Sydney, Australia More articles by this author Anne-Maree Haynes Sydney, Australia More articles by this author Richard Savdie Sydney, Australia More articles by this author Phillip Brenner Sydney, Australia More articles by this author Rob Sutherland Sydney, Australia More articles by this author Krishan Rasiah Sydney, Australia More articles by this author Phillip Stricker Sydney, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Severity of cardiovascular disease and health-related quality of life in men with prostate cancer: a longitudinal analysis from CaPSURE

ObjectiveTo evaluate the influence of comorbid cardiovascular disease severity on health-related quality of life (HRQL) in men treated with radical prostatectomy (RP) or radiotherapy (RT) for early stage prostate cancer.MethodsSubjects (n = 830) with non-metastatic disease who had been diagnosed in 2000–2002 were drawn from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). We evaluated the influence of cardiovascular disease (CVD) severity on generic and disease-specific HRQL before and 6, 12, 18, and 24 months after treatment with RP or RT. HRQL was measured with the SF-36 and the UCLA Prostate Cancer Index.ResultsMen with moderate (n = 193) or severe (n = 51) cardiovascular disease had worse pre-treatment HRQL than did men without CVD (n = 293) (P < 0.01); HRQL scores were worse in men referred for RT. During 24 months of follow-up, men with moderate or severe CVD had worse SF-36 physical and mental component summaries and worse bowel function at all time points (P < 0.05). Men with severe CVD also experienced a slower recovery in physical function (P = 0.03) and sexual functioning (P = 0.02) than did men without CVD.ConclusionsProstate cancer patients with moderate to severe CVD have worse HRQL during follow-up. Those with severe CVD recover their physical and sexual functioning more slowly after treatment.

Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer

Background Short-course preoperative radiotherapy and total mesorectal excision have decreased local recurrence rates from rectal cancer. However, the effect of this radiotherapy on bowel function and quality of life in these patients is not well understood. Methods Between 1999 and 2004, 34 patients underwent low anterior resection and either short-course preoperative radiation (N = 24) or surgery alone (N = 10). Quality of life and bowel function were assessed using validated instruments: European Organization of Research and Treatment of Cancer Quality of Life questionnaires, Fecal Incontinence Quality of Life Scale, and the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument. Results Patients treated with preoperative radiation had higher rates of fecal incontinence and showed a strong trend toward lower global quality-of-life scores. In addition, there was a trend toward worse bowel function in these patients. Conclusions Patients treated with short-course preoperative radiotherapy had worse continence-related quality of life than patients treated with surgery alone for rectal cancer. Fecal incontinence has a negative effect on quality of life in these patients, causing difficulty with coping, lifestyle, and depression, and limiting daily activities. Validated instruments provide standardized assessment of bowel function and quality of life.

Obesity Adversely Affects Health Related Quality of Life Before and After Radical Retropubic Prostatectomy

Obesity adversely affects surgical procedures and outcomes. We used a validated health related quality of life measure to examine the effects of obesity on disease specific health related quality of life before and following radical retropubic prostatectomy. From June 2000 to April 2003, 575 consecutive patients with prostate cancer were approached to participate in a prospective, health related quality of life study. Health related quality of life was assessed before surgery, and 1, 4, 12, 24 and 36 months postoperatively. Repeated measures mixed models were constructed to determine the independent effects of body mass index on health related quality of life. Of 472 consenting subjects 376 (80%) completed a baseline and at least 1 followup survey. Higher body mass index was associated with worse preoperative hormonal/vitality function (p = 0.0009) and bother (p = 0.02), and delayed recovery of bowel function (p = 0.01) and bother (p = 0.01) health related quality of life. There were no measurable differences postoperatively in hormonal/vitality, urinary or sexual health related quality of life associated with higher body mass index. Increased body mass index was associated with prostate specific antigen recurrence (p = 0.05) and adjuvant treatment (p = 0.02). Adjuvant treatment was independently associated with worse bowel function (p = 0.01) and bother (p = 0.01) health related quality of life in obese patients. At 24 months bowel health related quality of life in obese patients no longer significantly differed from that in nonobese patients. Obesity is associated with worse preoperative hormonal/vitality health related quality of life, slower recovery of bowel function and bother health related quality of life after radical retropubic prostatectomy, and prostate specific antigen recurrence. Impaired health related quality of life recovery in obese patients is influenced by disease recurrence and resultant adjuvant therapies. Despite these findings obese patients should not be dissuaded from considering prostatectomy as definitive treatment for localized prostate cancer.

Using patient-reported outcomes to assess prostate brachytherapy technique

4697 Background: Brachytherapy technique may affect prostate cancer treatment outcomes. One attempts to reduce urinary dysfunction by excluding the periurethral transitional zone from the target volume using MRI localization (MRB). In a small study, we found less short-term urinary and sexual function in patients after MRB, but worse bowel function. To assess the affect of technique, we compared patient-reported outcomes after MRB with those in 2 different academic practices using ultrasound and conventional target volumes (USB). Methods: In an ongoing cohort study, we surveyed patients with validated instruments to measure treatment-related urinary, bowel and sexual dysfunction before treatment (BL) and at 3 and 12 months. We abstracted clinical data from medical records. We report 12-month follow-up results. Results: Other than age, MRB and USB patient groups had similar favorable pretreatment demographic and clinical characteristics. MRB patients tended to increase urinary dysfunction less and bowel dysfunction more, without clear differences in sexual dysfunction. In addition, trends suggested changes in urinary and bowel dysfunction also differed between USB patient groups. Conclusions:These early results are consistent with our earlier observation that MRB patients have less short-term urinary dysfunction but more bowel dysfunction. We also found evidence that 2 different USB techniques in academic settings may produce different treatment-related outcomes. These observational data suggest that both intentionally distinct and apparently similar techniques may produce different treatment-related outcomes. Patient-reported data may contribute to technology assessment. No significant financial relationships to disclose.

Health related quality of life in Japanese men after radical prostatectomy or radiation therapy for localized prostate cancer.

We performed a retrospective survey of general and disease specific health-related quality of life (HRQOL) after radical prostatectomy (RP) and external beam radiotherapy (XRT) in Japanese men. A total of 186 patients underwent RP and 78 underwent XRT for clinically localized prostate cancer between 2000 and 2002. We measured the general and disease specific HRQOL with the MOS 36-Item Health Survey and the University of California, Los Angeles Prostate Cancer Index, respectively. Each treatment group was further divided into four subgroups according to the time scale. Patients from the RP group were significantly younger than those from the XRT group. The tumor characteristics differed significantly in their distributions among the treatment groups. Patients undergoing XRT had low scores in most of the general measures of HRQOL just after treatment, but after 6 months there were no differences between the treatment groups, except for the physical domains. The RP group was associated with worse urinary function, whereas the XRT group had worse bowel function and bother during the first 6 months after treatment. Thereafter, however, urinary and bowel domain did not differ between the groups. Both groups reported poor sexual function, although the RP group scored lower sexual bother. The patients who underwent RP had significantly worse urinary and better bowel function than those treated with XRT. Both treatment groups had decrements in sexual function throughout the post-treatment period; careful attention should be paid to this side-effect in preoperative counselling, especially in younger patients, regardless of the primary treatments.

Quality of life after treatment for prostate cancer.

Quality of life is a major concern of patients when they are choosing treatment for prostate cancer. Health-related quality of life is a patient-centered variable from the field of health services research that can be measured in a valid and reliable manner. Using standardized questionnaires specifically developed to capture health-related quality of life data in men with prostate cancer, the effect of treatments on patients' quality of life can be studied. Patients with localized disease who are undergoing radical prostatectomy tend to have more sexual and urinary dysfunction than men undergoing external beam radiation therapy, although both groups have more impairment in these areas than age-matched controls. Men undergoing external beam radiation therapy have worse bowel function and more urinary distress from irritative voiding symptoms than men undergoing radical prostatectomy or age-matched controls. Recent studies of men undergoing interstitial brachytherapy indicate that these patients have less urinary leakage than those who undergo radical prostatectomy, but experience considerably more irritating voiding symptoms, which often profoundly affect their quality of life. Better information regarding the potential impact of prostate cancer treatment on quality of life will improve medical decision-making.

QUALITY OF LIFE AFTER TREATMENT FOR LOCALIZED PROSTATE CANCER: DIFFERENCES BASED ON TREATMENT MODALITY

Brachytherapy with 103palladium (103Pd) is an increasingly administered treatment modality for localized prostate cancer. We compared general and disease specific health related quality of life after 103Pd treatment, radical prostatectomy and external beam radiation therapy given during the same time frame. We performed a retrospective cross-sectional survey study of patients treated at a single community medical center between 1995 and 1999. We mailed 5 validated health related quality of life survey instruments to 269, 142 and 222 men who underwent radical prostatectomy, 103Pd treatment and external beam radiation therapy, respectively, with a response rate of greater than 80% in all groups. General health related quality of life assessed by the SF-36 showed the same scores in patients who underwent prostatectomy and 103Pd treatment. The University of California-Los Angeles Prostate Cancer Index was used to assess bowel, urinary and sexual function/bothersomeness. External beam radiation therapy reported was associated with worse bowel function and greater bowel bothersomeness. Prostatectomy was associated with worse urinary function compared to 103Pd and external beam radiation therapy. Prostatectomy was associated with worse sexual function than 103Pd or external beam radiation therapy, although nerve sparing surgery and erectile aids minimized the difference. American Urological Association symptom scores were initially higher for 103Pd but became equal to those in the other groups in patients treated greater than 12 months from survey time. Disease-free men who underwent prostatectomy and 103Pd brachytherapy were equally confident that cancer would not recur in the future. Satisfaction rates were equivalent and biochemical failure significantly decreased satisfaction in all groups. While general health related quality of life was mostly unaffected by the 3 most common treatments for prostate cancer, there were differences in bowel, urinary and sexual function. This information may aid patients in the decision making process.

QUALITY OF LIFE OUTCOMES AFTER BRACHYTHERAPY FOR EARLY STAGE PROSTATE CANCER

We compare general and disease specific health related quality of life in men undergoing brachytherapy for early stage prostate cancer to those undergoing radical prostatectomy and age matched healthy controls. Cohorts consisted of 48 men treated with brachytherapy with and without pretreatment external beam radiation therapy (brachytherapy group), 74 who underwent radical prostatectomy (prostatectomy group) and age matched healthy controls from the literature. The RAND 36-item general health survey, University of California Los Angeles Prostate Cancer Index, American Urological Association symptom index, validated Cancer Interference with Life and Family Scales, and sociodemographic and co-morbidity questionnaires were completed 3 to 17 months after treatment. General health related quality of life did not differ greatly among the 3 groups. Urinary function (leakage) was worse in the brachytherapy group than in controls but better than in the prostatectomy group. Brachytherapy group patients had more irritative urinary symptoms and worse bowel function than controls. Sexual function and bother were worse in prostatectomy and brachytherapy groups than in healthy controls. Physical function, bodily pain, urinary function, and bother and American Urological Association symptom index scores improved with time after brachytherapy. Patients who underwent brachytherapy after external beam radiation performed worse in all general and disease specific health related quality of life domains compared to those who did not undergo pretreatment radiation therapy. At an average of 7.5 months after treatment the general health related quality of life of patients undergoing brachytherapy with and without pretreatment external beam radiation was similar to age matched controls, although urinary, bowel and sexual problems were reported. These problems appeared to improve during the first year after treatment. Much of the impairment in disease specific health related quality of life among patients undergoing brachytherapy may be attributed to pretreatment radiation.