Introduction:

Radiotherapy (RT) for prostate cancer in both the adjuvant and salvage setting is associated with distinct treatment related morbidity in terms of both complications and negative effects on the domains of sexual function, urinary and bowel health related quality of life. Few studies have reported the long-term health related quality of life (HRQOL) and complications after radiation treatment for prostate cancer. The aim of this study is to report the long term HRQOL and complications in patients from a nationwide, longitudinal prostate cancer registry. 

Methods:

We identified men diagnosed with prostate cancer who underwent radical prostatectomy (RP) alone and RP followed by RT from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry of primarily community based US urologic practices. Quality of life outcomes were measured with the Medical Outcomes Studies 36-item Short Form (SF-36) Physical Function (PF), Mental Health (MH), and General Health (GH) scores and the University of California, Los Angeles (UCLA) Prostate Cancer Index (PCI) Urinary Function (UF), Bowel Function (BF), and Sexual Function (SF) scores. For both patient-reported instruments, scores are 0-100, with higher scores denoting better function. Complications included were cystitis, fistula, incontinence, ureteral injury and urinary stricture. Repeated measures mixed models were used to assess change in HRQOL by treatment over time, adjusted for demographics, comorbidities, and clinical risk. Kaplan-Meier and log rank tests were used to describe the cumulative incidence of post-treatment complications. 

Results:

In total, 6331 men underwent RP and 671 went RP with RT. At diagnosis mean age was 61.5 years (SD 6.94) and CAPRA clinical risk was 58% low, 35% intermediate, and 7% high. Median time to RT was 49 months (IQR 2, 49), delivered as adjuvant (25%) or salvage (75%) therapy. Median follow up after treatment was 7.33 years (IQR: 3.83-13.3). Across all domains, patients who had RP with RT had lower adjusted HQROL score over time than patients who had RP alone, all p<0.01. (Figure 1) Patients with RP and RT had a higher cumulative incidence at 15 years of cystitis (10.2% vs 1.5%, log-rank p<0.01) and incontinence (36.7% vs. 9.5%, log-rank p<0.01) compared to men treated with RP alone. There was no difference noted in rates of stricture disease, fistula or ureteral injury between the RP and RP and RT groups. 

Conclusion:

Long term worsening of HRQOL is observed in all domains to a greater extent in RP and salvage RT compared to RP alone. Complications are more common in patients with RP and salvage RT, specifically cystitis and incontinence though there was no difference noted in rates of stricture disease, fistula or ureter injury. These findings will be helpful for shared decision making for men who are offered adjuvant or salvage RT for prostate cancer. 

Funding: N/A