Quality of Life Outcomes After Brachytherapy for Early Prostate Cancer

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Prostate Cancer and Prostatic Diseases (1999) 2 Suppl 3, S19±S20 ß 1999 Stockton Press All rights reserved 1365±7852/99 $15.00 http://www.stockton-press.co.uk/pcan Quality of life outcomes after brachytherapy for early prostate cancer

MS Litwin1, JM Brandeis1, CM Burnison1 and E Reiter1 1UCLA Departments of Urology, Health Services, and Radiation Oncology, UCLA, California, USA

Despite the absence of empirical evidence, there is a XRT. Sildena®l appeared to have little effect in the radical popular perception that brachytherapy results in less prostatectomy patients. However, brachytherapy patients impairment of health-related quality of life. This study not receiving hormonal ablation or XRT who took silde- compared general and disease-speci®c health-related na®l had better sexual function and bother scores than quality of life in men who had undergone either brachy- those patients who did not. therapy (with and without pre-treatment XRT) or radical prostatectomy, and in healthy age-matched controls.

Method Conclusion We surveyed all patients with clinical T2 or less prostate General health-related quality of life did not differ greatly cancer who had undergone interstitial seed brachyther- between the three groups, but there were variations in apy at UCLA during the previous 3±17 months. Each was disease-speci®c (urinary, bowel and sexual) health-related paired with two randomly selected, temporally matched quality of life. Radical prostatectomy patients had the radical prostatectomy patients. Healthy, age-matched worst urinary function (leakage), but brachytherapy controls were drawn from the literature. Surgery and patients were also signi®cantly worse than the controls. brachytherapy procedures were performed by board- Control subjects had less urinary bother than the radical certi®ed faculty physicians. Quality of life outcome mea- prostatectomy or brachytherapy patients, but brachyther- sures included the RAND 36-item Health Survey (SF-36), apy patients had more irritative and obstructive symp- the UCLA Prostate Cancer Index (PCI) and the American toms than the radical prostatectomy patients or controls. Urological Association Symptom Index (AUASI). Clinical Over time, brachytherapy improved in general health- variables were collected by chart abstraction. related quality of life domains, whereas the radical prostatectomy patients remained stable. Urinary leakage scores improved in both surgery and brachytherapy patients over time, while irritative and obstructive symp- Results toms improved in the brachytherapy patients. Despite similar age, co-morbidity and time since treatment, bra- Response rates were 86% (n 50) for the brachytherapy chytherapy patients who received pre-treatment XRT per- patients and 74% (n 76) for the radical prostatectomy formed worse in all quality-of-life domains than those patients. In the general health-related quality of life who did not receive pre-treatment XRT. Finally, sildena®l domains, brachytherapy and radical prostatectomy may be more effective in brachytherapy patients than in patients had similar scores to each other and to the patients who have undergone radical prostatectomy. healthy, age-matched controls. PCI urinary function (leak- The conclusions of this study are limited by its retro- age) was worst in radical prostatectomy patients, better in spective, cross-sectional design. However, the study pro- brachytherapy patients and best in the healthy controls. vides important insights into the quality of life of patients AUASI scores (irritative and obstructive symptoms) were who have undergone brachytherapy for early-stage pros- worse in the brachytherapy patients than in the radical tate cancer. At an average of 7.5 months after treatment, prostatectomy or control patients. PCI bowel function their general health-related quality of life was similar to was worse in the brachytherapy patients than in the that of the controls, although they had more urinary, controls. PCI sexual function and bother were equivalent bowel and sexual problems. These appear to improve in the radical prostatectomy and brachytherapy groups, during the ®rst year after treatment. In addition, their both of which were worse than the control group. The PCI erectile dysfunction may be effectively managed with urinary domains improved over time among the radical sildena®l. Much of the impairment in disease-speci®c prostatectomy and brachytherapy patients. AUASI scores health-related quality of life among brachytherapy were stable following radical prostatectomy, but patients may be attributed to the use of pre-treatment improved over time in the brachytherapy patients. Brachy- XRT. Nonetheless, brachytherapy with or without XRT therapy patients who received pre-treatment XRT had does affect health-related quality of life, and this must be worse general and disease-speci®c health-related quality clearly explained to patients, many of whom may expect of life and AUASI scores than those who did not receive a treatment free of side-effects. Quality of life after brachytherapy MS Litwin et al S20 Table 1 General and disease-speci®c health-related quality of life in patients undergoing radical prostatectomy (RRP) or brachytherapy (Brachy) and in healthy age-matched controls (mean Æ s.d.)

Group P value

Domain RRP Brachy Control Brachy vs RRP Brachy vs control RRP vs control

RAND 36-Item Health Survey Physical function 92 Æ 11 80 Æ 26 77 Æ 25 0.003 NS 0.001 Role limitations, physical 82 Æ 32 82 Æ 34 75 Æ 36 NS NS NS Bodily pain 85 Æ 19 80 Æ 24 78 Æ 24 NS NS NS General health perceptions 78 Æ 21 73 Æ 15 69 Æ 24 NS NS NS Emotional well-being 78 Æ 17 77 Æ 19 77 Æ 17 NS NS NS Role limitations, emotional 82 Æ 34 89 Æ 30 80 Æ 34 NS NS NS Social function 87 Æ 22 88 Æ 20 82 Æ 24 NS NS NS Energy/fatigue 68 Æ 20 66 Æ 20 65 Æ 21 NS NS NS UCLA Prostate Cancer Index Urinary: function 71 Æ 25 80 Æ 22 92 Æ 13 0.05 0.001 0.001 bother 74 Æ 29 65 Æ 32 86 Æ 23 NS 0.001 0.002 Bowel: function 87 Æ 13 81 Æ 20 88 Æ 13 NS 0.007 NS bother 90 Æ 22 81 Æ 28 89 Æ 19 0.05 0.03 NS Sexual: function 28 Æ 24 36 Æ 26 54 Æ 29 NS 0.009 0.001 bother 34 Æ 37 39 Æ 38 53 Æ 40 NS 0.05 0.001 AUA Symptom Index 7.2 Æ 5.8 12 Æ 8 7.2 Æ 0.3 0.002 0.001 NS

All quality of life scales may range from 0 to 100, with higher scores representing better outcomes, except the AUA Symptom Index, which may range from 0 to 35, with higher scores representing worse outcomes.