The association between radiotherapy (RT) timing after radical prostatectomy and long-term patient-reported health-related quality of life (HRQOL) in men with prostate cancer is unknown.
To measure long-term HRQOL in men with prostate cancer up to 15 years after prostatectomy with or without RT and examine whether early vs late postprostatectomy RT is associated with differences in sexual, urinary, and bowel HRQOL.
A prospective, multicenter, longitudinal cohort analysis using HRQOL data from the PROST-QA (2003-2006) and RP2 consortium (2010-2013) studies was conducted. Men with localized prostate cancer undergoing radical prostatectomy were included. Data were analyzed between May 8, 2023, and March 1, 2024. The study was conducted in 12 high-volume academic medical centers in the US.
Men were stratified based on receipt and timing of postprostatectomy RT: prostatectomy only, early RT (<12 months), and late RT (≥12 months).
Longitudinal sexual, incontinence, urinary irritation, bowel, and hormonal/vitality HRQOL were measured via the Expanded Prostate Cancer Index Composite at baseline; months 2, 6, and 12; and annually thereafter. Treatment groups were compared using multivariable linear mixed-effects models of change in longitudinal domain scores. Pad use for incontinence was measured longitudinally among men receiving postprostatectomy RT.
A total of 1203 men were included in the study: prostatectomy only (n = 1082), early RT (n = 57), and late RT (n = 64). Median age for the entire cohort was 60.5 (range, 38.8-79.7) years, and 1075 men (92.0%) were White. Median follow-up was 85.6 (IQR, 35.8-117.2) months. Compared with men receiving prostatectomy alone, those receiving postprostatectomy RT had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL. However, timing of postprostatectomy RT, specifically early vs late, was not associated with a long-term decrease in any HRQOL domain. There was evidence of improved recovery of sexual, continence, and urinary irritation scores among men receiving early RT compared with those receiving late RT after prostatectomy. Before the start of postprostatectomy RT, 39.3% of men in the early RT cohort and 73.4% of men in the late RT cohort were pad-free. By the sixth visit post-RT, 67.4% in the early RT cohort and 47.6% in the late RT cohort were pad-free.
In this multicenter, prospective analysis, postprostatectomy RT appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy RT may result in similar long-term HRQOL outcomes.
JAMA network open. 2024 Oct 01*** epublish ***
Sagar A Patel, Dattatraya Patil, Joseph Smith, Christopher S Saigal, Mark S Litwin, Jim C Hu, Matthew R Cooperberg, Peter R Carroll, Eric A Klein, Adam S Kibel, Gerald L Andriole, Misop Han, Jeff M Michalski, David P Wood, Larry A Hembroff, Daniel E Spratt, John T Wei, Howard M Sandler, Daniel A Hamstra, Louis Pisters, Deborah Kuban, Meredith M Regan, Andrew Wagner, Catrina M Crociani, Irving Kaplan, Martin G Sanda, Peter Chang, PROST-QA/RP2 Consortium
Department of Radiation Oncology, Emory University, Atlanta, Georgia., Department of Urology, Emory University, Atlanta, Georgia., Department of Urology, Vanderbilt University, Nashville, Tennessee., Department of Urology, University of California, Los Angeles., Department of Urology, Weill Cornell Medical College, New York, New York., Department of Urology, University of California, San Francisco., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio., Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts., Department of Urology, Johns Hopkins University, Baltimore, Maryland., Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri., Department of Urology, Beaumont Health, Royal Oak, Michigan., Office of Survey Research, Michigan State University, East Lansing., Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio., Department of Urology, University of Michigan, Ann Arbor., Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, California., Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston., Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts., Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts., Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.