Quality of life for prostate cancer treatments

The 3-year results of a nonra-ndomized trial from Spain reveal different patterns of adverse events after three leading treatments for localized prostate cancer.

Radical retropubic prostatectomy (RRP) was associated with significantly more urinary incontinence and sexual dysfunction than was external beam radiotherapy or brachytherapy.

Brachytherapy, however, was associated with far more irritative and obstructive urinary symptoms than was surgery or external beam radiotherapy (EBRT).

The investigation was conducted in 11 hospitals throughout Spain, and originally enrolled 435 men with stage T1 and T2 prostate cancer who had received no prior surgical resection or hormonal treatment.

The objective of the clinical trial was to compare the health-related quality of life (HRQoL) impact of the three most commonly used primary treatments in men who were followed from before treatment to 3 years after intervention.

Treatment decisions were made jointly by physicians and patients; the analysis covered 123 men who underwent RRP, 127 who had ERBT, and 123 who had brachytherapy.

During the study, HRQoL was assessed using several validated questionnaires before and at 1, 3, 6, 12, 24 and 36 months after treatment.

The questionnaires used included the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index.

This is a very important study because it takes into account the previous stage in quality of life of our patients, before they received any treatment.

They also have the results of 3 years of follow-up. That is a very long follow-up for different types of treatment.

Previously published results showed that despite partial recovery from immediate deterioration in HRQoL, relevant differences persisted with 2 years follow-up and the latest findings have just been accepted for publication in Journal of Clinical Oncology.

The 3-year results also show that in each treatment group, HRQoL deteriorated immediately after receiving any of the prostate cancer treatments, but rose after the intervention to varying degrees.

SF-36 Physical Component scores decreased most dramatically after prostatectomy compared with either radiotherapy technique, but rose in the first 6 months after the procedure before gradually deteriorating over the 3 years follow-up. EBRT produced lower scores than those for brachytherapy and these gradually worsened during long-term follow-up such that they were lower at 3 years than were scores in the years in the patients who had undergone surgery.

RRP caused considerable urinary incontinence and sexual dysfunction. Brachytherapy and EBRT caused moderate urinary irritative obstructive urinary symptoms and moderate adverse effects on sexual function, and finally, EBRT had very moderate bowel-related adverse events.

These results are useful to consider when discussing treatment options with patients, particularly in light of other studies showing the significant benefits of all treatments in terms of tumor control and improved overall survival.