In a prospective analysis reported in JAMA Network Open, Patel et al found that long-term health-related quality of life (HRQOL) was poorer among patients with prostate cancer who received postprostatectomy radiotherapy vs those who did not, with little difference observed among patients with early vs late postprostatectomy radiotherapy.
Study Details
The study involved data on men with localized prostate cancer undergoing radical prostatectomy at 12 high-volume U.S. centers in the PROST-QA study (2003–2006) and RP2 consortium study (2010–2013). Patients were followed for up to 15 years for HRQOL measured with the Expanded Prostate Cancer Index Composite, including sexual, incontinence, urinary irritation, bowel, and hormonal/vitality domains. Early radiotherapy and late radiotherapy were defined as radiotherapy at up to 12 months and at least 12 months after prostatectomy, respectively.
Key Findings
Among a total of 1,203 men included in the study, 1,082 received prostatectomy alone and 121 received early radiotherapy (n = 57) or late radiotherapy (n = 64). Median patient age was 60.5 years, and 92% of patients were White. Median follow-up was 85.6 months (interquartile range = 35.8–117.2 months).
Compared with patients who had prostatectomy alone, those receiving postprostatectomy radiotherapy had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL domains. However, as stated by the investigators, “Timing of postprostatectomy radiotherapy (ie, < 12 vs ≥ 12 months) was not associated with a decrease in sexual, incontinence, and urinary irritation domains at long-term follow-up.” There was evidence of improved recovery of sexual, incontinence, and urinary irritation scores among patients receiving early vs late radiotherapy.
Prior to postprostatectomy radiotherapy, 39.3% of men in the early radiotherapy group and 73.4 % of men in the late radiotherapy group were incontinence pad-free. By the sixth post-radiotherapy visit, 67.4% and 47.6% were pad-free.
The investigators concluded: “In this multicenter, prospective analysis, postprostatectomy [radiotherapy] appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy [radiotherapy] may result in similar long-term HRQOL outcomes.”
Sagar A. Patel, MD, MSc, of the Department of Radiation Oncology, Emory University, Atlanta, is the corresponding author of the JAMA Network Open article.
Disclosure: The study was supported by the National Institutes of Health. For full disclosure information for all study authors, visit JAMA Network Open.
