International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationsQuality of life in T1–3N0 prostate cancer patients treated with radiation therapy with minimum 10-year follow-up☆
Introduction
Quality of life (QOL) post-treatment is critically important in prostate cancer (CaP) patients because of the long life most patients enjoy after their diagnosis. In this review we discuss QOL in a cohort of surgically staged CaP patients with long follow-up. All patients were treated with definitive radiotherapy (XRT). This cohort of patients has been discussed in detail previously with respect to overall and disease-free survival (1), prostate-specific antigen (PSA) status of long-term survivors (2), and frequency of second primary malignancies (3).
Prior studies have emphasized QOL in patients with short follow-up postradiotherapy. Some studies have investigated complication rates a few years after XRT, but most focus on the time frame to 1 year post-therapy. Many studies report objective findings at time of follow-up; however, there is an emerging literature on patient-reported questionnaire data, which better describes the effect of the toxicity on the patient.
Our well-defined cohort of 146 patients receiving radiotherapy after negative pelvic lymph node dissection for T1–3 CaP represents a fertile group for analysis of QOL in radiotherapy patients with long follow-up. Specifically discussed are results in patients with minimum 10 years follow-up.
Section snippets
Methods and materials
At Naval Medical Center San Diego, between November 1, 1974 and August 1, 1988, 165 men with clinically organ-confined CaP were staged with open pelvic lymph node dissection prior to definitive radiotherapy. Nineteen men were found to have positive lymph nodes; the remaining 146 received definitive radiotherapy, generally treated with four-field, opposed anteroposterior, or arc technique to a median of 66.7 Gy (range 63–70.2 Gy). The average patient age at diagnosis was 66.7 years.
Techniques of
General health-related QOL
Comparison of our population was made with a control cohort of similar age men without prostate cancer (8). Results are summarized in Table 2. Our population is similar in terms of the SF-36 assessment tool, but appears to have more fatigue and greater physical role limitations.
Disease-specific QOL
Appendix I shows the survey results of the UCLA Prostate Cancer Index, and Table 3 shows comparison of these results with other series (4, 8). Sexual function scoring in our cohort was similar to postprostatectomy
Discussion
Quality of life has emerged as a critical endpoint in clinical cancer therapy (9). In a recent review of complications after XRT for T1–2 CaP, with a median follow-up of 6.1 years, frequencies of 5.1–5.4% were reported for genitourinary strictures, hematuria, and rectal bleeding (10). These are raw percentages, however, and do not reflect the effect that any toxicity had on the patient’s life. It is conceivable that a complication may severely impact one patient’s QOL, while another patient may
Conclusion
In a cohort of patients receiving definitive radiotherapy after negative pelvic lymphadenectomy, disease-specific QOL with long follow-up appears somewhat worse than in comparable recent patients reported with less follow-up. Since general health QOL is in keeping with similar age-matched controls, this discrepancy may be due to (a) progression of symptoms with longer follow-up, or (b) different radiotherapy techniques.
Acknowledgements
The kind assistance of Mark Litwin, M.D., in making the quality-of-life assessment tool available to us is acknowledged and gratefully appreciated.
References (22)
- et al.
Outcome for surgically staged localized prostate cancer treated with external beam radiation therapy
J Urol
(1997) - et al.
Second primary malignancies in T1–3N0 prostate cancer patients treated with radiation therapy with 10-year followup
J Urol
(1998) Health related quality of life in older men without prostate cancer
J Urol
(1999)- et al.
Treatment related sequelae following external beam radiation for prostate cancerA review with an update in patients with stages T1 and T2 tumor
J Urol
(1994) - et al.
Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual functionThe patient’s perspective
Urology
(1996) - et al.
Late effects after radiotherapy for prostate cancer in a randomized dose–response studyResults of a self-assessment questionnaire
Urology
(1998) - et al.
Cancer control and quality of life following anatomical radical retropubic prostatectomyResults at 10 years
J Urol
(1994) - et al.
Differences in urologist and patient assessment of health related quality of life in men with prostate cancerResults of the CAPSURE database
J Urol
(1998) - et al.
Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis
Urology
(1994) - et al.
Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancerA randomized trial
Lancet
(1999)
The fate of clinically recurrence-free survivors after definitive radiotherapy for T1–3N0 prostate cancer
Radiat Oncol Investig
Cited by (26)
Bowel, Urinary, and Sexual Problems Among Long-Term Prostate Cancer Survivors: A Population-Based Study
2009, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Knowledge of disease-specific complaints among long-term prostate cancer survivors is important because of the long life most patients experience after diagnosis. However, the number of relevant studies is small (17, 19–23). Most important, thus far no population-based study has been conducted that included both a large study population and a reference group and that also evaluated all available treatment options.
Salvage Radical Prostatectomy: Quality of Life Outcomes and Long-Term Oncological Control of Radiorecurrent Prostate Cancer
2006, Journal of UrologyCitation Excerpt :This rate is nearly identical to those reported in other salvage series using a similar method of analysis.6,7 Because definitive RT is often associated with long-term erectile dysfunction,11,14–16 sexual function may be less of a concern for the cohort of men considering salvRP than for the population of men seeking standard, nonsalvage prostatectomy. Given the frequency of erectile dysfunction following RT, it is not surprising that after salvRP nearly all men will be unable to achieve an erection adequate for intercourse.
Late rectal symptoms and quality of life after conformal radiation therapy for prostate cancer
2006, Radiotherapy and OncologyEarly prostate cancer: Prevention, treatment modalities, and quality of life issues
2003, European UrologyHealth related quality of life in men with prostate cancer
2003, Journal of UrologyEffect of age on biochemical disease-free outcome in patients with T1-T3 prostate cancer treated with definitive radiotherapy in an equal-access health care system: A radiation oncology report of the Department of Defense Center for Prostate Disease Research
2003, International Journal of Radiation Oncology Biology Physics
- ☆
The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program sponsored this report #S98-055, as required by HSETCINST 6000.41A. The opinions and assertions contained herein are those of the authors and are not to be construed as official or representing the views of the United States Navy or Department of Defense.