방사선의학 웹진

바로가기  >

Abstract

IMPORTANCE:

Patients diagnosed with localized prostate cancer have to decide among treatment strategies that may differ in their likelihood of adverse effects.

OBJECTIVE:

To compare quality of life (QOL) after radical prostatectomy, external beam radiotherapy, and brachytherapy vs active surveillance.

DESIGN, SETTING, AND PARTICIPANTS:

Population-based prospective cohort of 1141 men (57% participation among eligible men) with newly diagnosed prostate cancer were enrolled from January 2011 through June 2013 in collaboration with the North Carolina Central Cancer Registry. Median time from diagnosis to enrollment was 5 weeks, and all men were enrolled with written informed consent prior to treatment. Final follow-up date for current analysis was September 9, 2015.

EXPOSURES:

Treatment with radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance.

MAIN OUTCOMES AND MEASURES:

Quality of life using the validated instrument Prostate Cancer Symptom Indices was assessed at baseline (pretreatment) and 3, 12, and 24 months after treatment. The instrument contains 4 domains-sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems-each scored from 0 (no dysfunction) to 100 (maximum dysfunction). Propensity-weighted mean domain scores were compared between each treatment group vs active surveillance at each time point.

RESULTS:

Of 1141 enrolled men, 314 pursued active surveillance (27.5%), 469 radical prostatectomy (41.1%), 249 external beam radiotherapy (21.8%), and 109 brachytherapy (9.6%). After propensity weighting, median age was 66 to 67 years across groups, and 77% to 80% of participants were white. Across groups, propensity-weighted mean baseline scores were 41.8 to 46.4 for sexual dysfunction, 20.8 to 22.8 for urinary obstruction and irritation, 9.7 to 10.5 for urinary incontinence, and 5.7 to 6.1 for bowel problems. Compared with active surveillance, mean sexual dysfunction scores worsened by 3 months for patients who received radical prostatectomy (36.2 [95% CI, 30.4-42.0]), external beam radiotherapy (13.9 [95% CI, 6.7-21.2]), and brachytherapy (17.1 [95% CI, 7.8-26.6]). Compared with active surveillance at 3 months, worsened urinary incontinence was associated with radical prostatectomy (33.6 [95% CI, 27.8-39.2]); acute worsening of urinary obstruction and irritation with external beam radiotherapy (11.7 [95% CI, 8.7-14.8]) and brachytherapy (20.5 [95% CI, 15.1-25.9]); and worsened bowel symptoms with external beam radiotherapy (4.9 [95% CI, 2.4-7.4]). By 24 months, mean scores between treatment groups vs active surveillance were not significantly different in most domains.

CONCLUSIONS AND RELEVANCE:

In this cohort of men with localized prostate cancer, each treatment strategy was associated with distinct patterns of adverse effects over 2 years. These findings can be used to promote treatment decisions that incorporate individual preferences.

Comment in Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer: Helping Decision Making for Patients and Their Physicians. [JAMA. 2017]​

Key Points

Question 

What differences in quality of life are associated with radical prostatectomy, external beam radiotherapy, brachytherapy, and active surveillance after treatment for prostate cancer?

Findings

In this population-based, prospective cohort of 1141 men diagnosed from January 2011 through June 2013, radical prostatectomy was associated with worse sexual dysfunction and urinary incontinence compared with active surveillance, external beam radiotherapy and brachytherapy with worse short-term urinary obstruction and irritation, and external beam radiotherapy with worse short-term bowel symptoms. However, by 24 months, mean scores between treatment groups vs active surveillance

were not significantly different in most domains.

Meaning 

Contemporary treatment strategies were associated with distinct patterns of adverse effects over 2 years.​

Author information

Chen RC1, Basak R2, Meyer AM3, Kuo TM4, Carpenter WR4, Agans RP5, Broughman JR2, Reeve BB6, Nielsen ME7, Usinger DS4, Spearman KC4, Walden S4, Kaleel D4, Anderson M8, Stürmer T3, Godley PA9.​

1 Department of Radiation Oncology, University of North Carolina at Chapel Hill2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.

2 Department of Radiation Oncology, University of North Carolina at Chapel Hill.

3 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill4Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

4 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill.

5 Carolina Survey Research Laboratory, University of North Carolina at Chapel Hill.

6 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill6Department of Health Policy and Management, University of North Carolina at Chapel Hill.

7 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill6Department of Health Policy and Management, University of North Carolina at Chapel Hill7Department of Urology, University of North Carolina at Chapel Hill.

8 Patient stakeholder, Prostate Cancer Coalition of North Carolina, Raleigh.

9 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill9Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill.