Background: As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post- treatment and using the same validated QOL instrument.
Methods: Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed usingChi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL.
Results: The largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients.
Conclusions: Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.
Acknowledgments: We thank Oriol Cunillera Puértolas, MSc for providing the SAS code for the GEE analysis; Tami Crabtree, M.S. for performing the GEE statistical analysis; and Pam Commike, Ph. D. (Accuray Inc.) for editorial assistance.
This work was supported by grants from Instituto de Salud Carlos III FEDER (ETE- PI08/90090) and FIS PI020668; DURSI-GENCAT (2005-SGR-00491; 2009 SGR 1095); and AATRM 086/24/2000.
Alan Katz,1* Montserrat Ferrer,2,3,4 and José Francisco Suárez5
Multicentric Spanish Group of Clinically Localized Prostate Cancer; 1Flushing Radiation Oncology, 4022 Main St # 3, Flushing, NY 11354, USA; 2Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; 3CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; 4Universitat Autònoma de Barcelona, Bellaterra, Spain; 5Servicio de Urología, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
*Corresponding Author:
Author Disclosures: A. Katz has received reimbursement as a consultant for Accuray, Inc.. M. Ferrer and J. Francisco Suárez have no financial conflicts of interest.
Reference: Radiation Oncology 2012, 7:194
doi: 10.1186/1748-717X-7-194
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