Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer

Alan Katz, Montserrat Ferrer, José F. Suárez, Jordi Alonso, Adela Virginia Becerra, Oriol Cunillera, Olatz Garín, Yolanda Pardo, Angels Pont, Ana Boladeras, Ferran Ferrer, Ferran Guedea, Evelyn Martínez, Victoria Eugenia Padin, Joan Pera, Montse Ventura, Ferran Aguiló, Sergio Pastor, Josep Maria Prats, Javier Ponce de LeónHumberto Villavicencio, Jose Emilio Batista, Jordi Craven-Bratle, Gemma Sancho, Adriana Ayala, Belen de Paula, Pablo Fernández, Benjamin Guix, Ismael Herruzo, Helena Hernández, Víctor Muñoz, Asunción Hervas, Alfredo Ramos, Víctor Macias, Josep Solé, Marta Bonet, Pilar Marcos, Alfonso Mariño, María José Ortiz, Pedro J. Prada

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15 Citations (Scopus)

Abstract

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 using Chi-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. © 2012 Katz et al.; licensee BioMed Central Ltd.
Original languageEnglish
Article number194
JournalRadiation Oncology
Volume7
DOIs
Publication statusPublished - 20 Nov 2012

Keywords

  • Prostate cancer
  • Prostatectomy
  • Quality of life
  • Stereotactic body radiotherapy

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