This is the quality of life (QOL) analysis of the SPPORT trial of men with a detectable prostate specific antigen (PSA) after prostatectomy for prostate cancer. Primary analysis established a benefit of adding pelvic lymph node radiotherapy (PLNRT) and short-term androgen deprivation therapy (STADT) to salvage prostate bed radiotherapy (PBRT) for biochemical progression-free survival.
Subjects were randomized to Arm 1, PBRT, Arm 2, 4-6 months of STADT + PBRT, and Arm 3, PLNRT + STADT + PBRT. QOL was assessed at baseline, 6 weeks after the start of RT, 1 and 5 years after the end of RT, including Expanded Prostate Cancer Index Composite (EPIC), Hopkins Symptom Checklist (HSCL-25), EuroQol (EQ-5D), and quality adjusted life years (QALYs). Statistical and clinical significance were calculated. Differences among arms were assessed using pairwise t-tests, Fisher's exact test, and mixed effects regression modeling, controlling for multiplicity.
644 patients consented to QOL; 81% white and 54% <65 years. EPIC, bowel and urinary scores decreased at 6 weeks then increased by years 1 and 5, although not to baseline. For sexual and hormonal domains, there were statistically significant differences between arms at 6 weeks and 1 year with STADT exhibiting poorer QOL scores, but no difference at 5 years. For HSCL-25, statistically significant differences at 6 weeks were not clinically significant. Comparisons of QALYs for overall survival showed no statistical significance. However, freedom from progression QALY means were 5.5, 6.2 and 6.6 years for Arms 1, 2, and 3, respectively, with Arms 3 and 2 indicating statistically significant improvement over Arm 1.
While QOL generally declined the most among all arms at 6 weeks post RT start, and remained lower than baseline at 5 years, there were no clinically significant differences in QOL among arms at 1 and 5 years. QALYs for freedom from progression favored STADT + PLNRT + PBRT for salvage treatment of prostate cancer.
International journal of radiation oncology, biology, physics. 2026 Jul 14 [Epub ahead of print]
Deborah W Bruner, Theodore G Karrison, Alan Pollack, Jeff M Michalski, Alexander G Balogh, George B Rodrigues, Eric M Horwitz, Sergio L Faria, Andrew S Camarata, R Jeffrey Lee, Himanshu R Lukka, Michael Zelefsky, Wendy Seiferheld, Howard Sandler, Benjamin Movsas
Emory University Hospital/Winship Cancer Institute, Atlanta, GA. Electronic address: ., NRG Oncology Statistics and Data Management Center, Philadelphia, PA; University of Chicago, Chicago IL., University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, FL., Washington University School of Medicine, St Louis, MO., Tom Baker Cancer Centre, Calgary, AB, Canada., London Regional Cancer Program, London, ON, Canada., Fox Chase Cancer Center and Lewis Katz School of Medicine at Temple University, Philadelphia, PA., McGill University Health Centre, Glen site, Montreal, QC, Canada., Uniformed Services University of the Health Sciences, Bethesda, MD., Intermountain Medical Center, Murray, UT., Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada., New York University Langone Medical Center, New York, NY., NRG Oncology Statistics and Data Management Center, Philadelphia, PA; American College of Radiology, Philadelphia PA., Oregon Health & Science University, Portland, OR., Henry Ford Cancer Institute, Detroit, MI.