(UroToday.com) The 2023 SESAUA annual meeting included a prostate cancer session, featuring a presentation by Dr. Anders Olsen discussing long-term health-related quality of life in prostate cancer patients requiring radiotherapy after radical prostatectomy. The optimal timing of radiotherapy after radical prostatectomy for biochemical recurrence is controversial, and the impact of early versus late post-radical prostatectomy radiotherapy on patient-reported health-related quality of life is unclear.
In this study, 1,203 men with localized prostate cancer were prospectively enrolled in the PROSTQA (2003-2006) and RP2 (2010-2014) consortiums. These men were treated with radical prostatectomy and 121 subjects received post-radical prostatectomy radiotherapy for biochemical recurrence. The exposure of interest was receipt and timing of post-radical prostatectomy radiotherapy, leading to three treatment cohorts:
1) Radical prostatectomy only (n=1,082)
2) Radical prostatectomy + early radiotherapy (n=57)
3) Radical prostatectomy + late radiotherapy (n=64)
Early versus late radiotherapy was defined as ≤12 months and >12 months post-radical prostatectomy, respectively. The primary outcome was health-related quality of life via the Expanded Prostate Cancer Index Composite (EPIC-26) sexual, urinary incontinence and urinary irritation/obstruction scores, measured at pre-treatment and annually thereafter. Treatment groups were compared using multivariable GEE models of change in longitudinal health-related quality of life domain scores. Urinary incontinence pad usage was also evaluated before and after post-radical prostatectomy radiotherapy.
The median follow-up for the entire cohort was 85.6 months (IQR 35.8-117.2). Compared to radical prostatectomy alone, subjects undergoing post-radical prostatectomy radiotherapy had significantly worse longitudinal changes in sexual, urinary incontinence and urinary irritation/obstruction health-related quality of life (p-values: 0.03, 0.004, <0.001, respectively). There were no differences in health-related quality of life between late and early radiotherapy longitudinally, perhaps secondary to the small sample size of the radiotherapy cohort. Longitudinal differences between the three cohorts with regard to urinary incontinence and sexual function is highlighted as follows:
Post-radical prostatectomy recovery for urinary control was noted for early radiotherapy, as 49% of subjects were pad-free before radiotherapy, and 70% were pad free at their next health-related quality of life evaluation. At five years after radiotherapy (n=40), 69% of early radiotherapy subjects and 47% of late radiotherapy subjects endorsed no pad usage.
Dr. Olsen concluded his presentation discussing long-term health-related quality of life in prostate cancer patients requiring radiotherapy after radical prostatectomy with the following take-home messages:
- This prospective cohort study with long-term follow-up confirms the detrimental impact of radiotherapy on post-radical prostatectomy health-related quality of life
- Distinguishing differences between late and early radiotherapy after radical prostatectomy was not demonstrable, limited by the size of the post-radical prostatectomy radiotherapy cohorts
- Further study is needed to assess the differential impact of treatments and prostate cancer recurrence/progression on health-related quality of life
Presented by: T. Anders Olsen, MD, Emory School of Medicine Department of Urology, Atlanta, GA
Co-Authors: Sagar Patel, Atlanta, GA2, Dattatraya Patil, Atlanta, GA2, Catrina Crociani, Atlanta, GA3, Louis Alperti, Atlanta, GA4, Peter Chang, Boston, MA3, Martin Sanda, Atlanta, GA5
Affiliations: 2. Emory Winship Cancer Institute, 3. Beth Israel Deaconess Medical Center Department of Urology, 4. Urology of St. Louis, 5. Emory Winship Cancer Institute and Department of Urology
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Amelia Island, FL, Wed, Mar 15 – Sat, Mar 18, 2023.