AUA 2017: Long-Term Health Related Quality of Life in Prostate Cancer Patients Requiring Radiotherapy After Radical Prostatectomy

Boston, MA ( Biochemical recurrence (BCR) and local recurrence rates post- radical prostatectomy (RP) vary per surgeon and per institution. Per ASTRO / AUA guidelines, radiation therapy (RT) should be offered in the adjuvant setting given pathological indication and as salvage treatment upon BCR. However, from the patient perspective, decreased urinary and sexual health –related quality of life (HRQOL) post-RT is a major concern.

Dr. Louis Aliperti (MD) reports HRQOL in a two-part, multi-center series of post-RP patients with adjuvant and salvage RT. Of the 1121 men who underwent RP from 2003 to 2013, 1097 had RP-only treatment for PC, 57 had subsequent adjuvant RT within one year of surgery, while 50 had salvage RT at greater than one year follow-up. Mean pre-operative PSA levels were higher in the adjuvant series (10.2ng/mL) compared to those in the RP-only (6.3 ng/mL) and salvage RT (7.8 ng/mL); Gleason distribution was also significantly higher patients offered adjuvant RP.

Patients receiving post-RP RT had worse outcomes in sexual, urinary incontinence, and urinary irritation domains (p<0.05). When salvage versus adjuvant RT was directly compared, adjuvant XRT had worse sexual HRQOL than RP-only in the first 2 years follow-up. Interestingly, salvage XRT patients continued to have consistently worse sexual HRQOL through 9 years of follow-up (p<0.05), though there were no statistically significant differences in urinary irritation or incontinence domains.

Overall, Dr. Aliperti and colleagues observe pronounced quality of life variations between patients who received adjuvant versus salvage RT post-RP. While the reported series is a robust, multi-center analysis with over 10 years follow-up, results may have limited application with or without concurrent hormonal therapy. Future studies utilizing standardized definitions for salvage versus adjuvant RT and controlling for baseline differences between subjects are receommended to further validate these findings.

Authors: Louis Aliperti*, Dattatraya Patil, Akanksha Mehta, Christopher Filson, Catrina Crociani, Martin Sanda, Peter Chang,

Presented by: Louis Aliperti, MD, Emory University School of Medicine, Department of Urology

Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA