BERKELEY, CA (UroToday.com) - Without prospective, randomized data comparing oncologic outcomes of brachytherapy (BT), radiotherapy (XRT), and radical prostatectomy (RP), focus on patient quality of life (QOL) can potentially drive patient decision-making. In the online version of Cancer, Dr. Mark Litwin reports on a prospective QOL assessment of these 3 treatments performed between 1999 and 2003.

The treatment distribution was RP (307 men), XRT (78 men) and BT (90 men). Follow-up assessments were performed routinely over a 24-month period. General health related QOL (HRQOL) was performed with the Short Form-36 that consolidates 8 domains into physical and mental summary scores. The disease-specific QOL was evaluated using the UCLA prostate cancer index (PCI) and the AUA symptom score index. Surgical patients had their nerve sparing quantified by the surgeons. Short-term androgen deprivation therapy was given to 23% of the BT patients.

The data was reported on 475 participants (82%) who had complete follow-up assessments. Surgical patients were younger, but comorbidities did not differ among treatment groups. By treatment category, men reported to be potent prior to treatment were 51% in the RP group, 20% in the XRT group and 18% in the BT group. Participants who underwent a bilateral nerve-sparing RP had a greater initial loss of sexual function than those treated with XRT or BT, but the RP patients had greater long-term improvement. XRT patients were more likely than BT patients to return to baseline sexual function. Unilateral or non nerve-sparing RP were less likely than BT patients to return to baseline sexual function. Long-term sexual function scores were better among RP patients, but the baseline scores were much higher.

Post-treatment urinary bother was similar between RP and BT patients, but worse immediately after therapy than those treated with XRT. After 4 months there was no difference between groups. Up to one-third of BT patients had an exacerbation of obstructive urinary symptoms 24 months after therapy. RP had worse urinary control in the immediate post-op period, but continued to improve beyond 2 years after surgery. RP patients had minimal effect on bowel symptoms after RP.

Mark S. Litwin, John L. Gore, Lorna Kwan, Judson M. Brandeis, Steve P. Lee, H. Rodney Withers, Robert E. Reiter

Cancer 2007; epub

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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