Prostatectomy with or without post-operative radiotherapy: long-term adverse effects and quality of life

Abstract

Background

Few longitudinal studies have compared patient-reported long-term adverse effects after radical prostatectomy (RP) alone and RP followed by radiotherapy (RAD), also analyzing the effect of the development of post-treatment dysfunctions/problems (Symptom Burden) on Health-Related Quality of Life (HRQoL).

Material and methods

After median seven years since RP and six years since post-RP RAD, development of EPIC-26 Domain Summary Scores (DSS Changes) and HRQoL scores (SF-12) since the pre-RP situation were evaluated in respectively 317 prostatectomized men without and in 63 patients with additional post-RP RAD. Post-treatment inter-group differences of the prevalent Symptom Burden and of the DSS Changes were calculated. Multivariable logistic regressions evaluated the associations between DSS Changes and post-treatment impaired HRQoL.

Results

Compared to RP alone, post-RP RAD increased the post-treatment Symptom Burden, with least inter-group differences within the urinary irritative/obstructive and bowel domain. No significant inter-group difference emerged for the proportions of men with impaired HRQoL. The odds of impaired HRQoL increased significantly with rising DSS Changes (worsening) within the vitality/hormonal domain. Worsening within urinary incontinence and bowel domains significantly increased the odds of impaired physical QoL. High HRQoL scores before RP reduced the odds of post-treatment impaired HRQoL. Living without a partner and use of androgen deprivation therapy increased this odds.

Conslusions

Post-RP radiotherapy increases post-treatment Symptom Burden with negative, though limited impact on the patient’s HRQoL. Counceling before post-RP radiotherapy should cover this possible development, taking into account the patient’s social situation.

Keywords:

• Radical prostatectomy
• post-operative pelvic radiotherapy
• adverse effects
• EPIC-26
• quality of life
• SF-12

Acknowledgements

The authors thank Siri Lothe Hess and Vigdis Opperud for support during collecting data and for layout tips of this study.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was financially supported by the Norwegian Cancer Society [Grant no. 5781243], the Movember Foundation [Grant no. 144974] and the Radium Hospital Foundation [Grant no. 335007].