Comparison of health-related quality of life (HRQOL) after brachytherapy, radical prostatectomy, or external beam radiation for localized prostate cancer

Theodore Robnett, MD
OncoLink Assistant Editor
Last Modified: May 22, 2000

Presenter: M.G. Sanda
Affiliation: University of Michigan

Many oncologists believe that in selected patients, the differences between disease free survival and overall survival for radical prostatectomy (RP), external beam radiation therapy (ERT), and brachytherapy (BT) are negligable. Given the rough equivalence of these procedures, quality of life (QOL) issues between treatment modalities become of primary importance. This analysis is designed to compare QOL issues for patients treated with RP, ERT, and BT.

Materials and Methods:

  • This is a cross-sectional cohort survey of all patients who received BT, RP, or ERT from 6/95 through 5/99. Survey instruments included SF-36, FACT-P, AUA symptom score, and a 51 item modified UCLA prostate cancer index.

  • Analysis of covariance (ANCOVA) was used to compare HRQOL between therapy groups, controlling for age, time from treatment, and pre-treatment disease severity.

  • Tukey's multiple comparison adjustment was used to compare pairwise group differences.

  • A total of 826 cases were analyzed: BT = 77, ERT = 154, RP = 595. Response rates were similar (70%-71%). The median follow-up time since therapy was 2.6 years.

  • Urinary function was significantly better after ERT than after RP or BT. Bowel function and hormonal function was better after RP than after ERT or BT. Differences in hormonal function may have been due to adjuvant androgen ablation. Sexual function was similar among all groups.

  • Urinary and bowel function bothered patients after BT significantly more than after either RP or ERT.
Authors' Conclusions

  • Significant therapy-associated HRQOL differences after BT, RP, or ERT are measurable using a composite survey instrument.

  • HRQOL after ERT or RP in this cohort compared favorably to HRQOL after BT.
Clinical/Scientific Implications:

  • These results are surprising in that previous studies of BT have reported improved sexual function relative to ERT. Bowel problems are believed to be less with BT as well. Similarly, urinary function with BT is generally thought to be better than that with ERT, and often as good or better than that with RP.

  • Baseline surveys of patient expectations prior to treatment are in order. Often, patients who receive BT are of higher socioeconomic status and therefore select treatment based on their own research and expectations.

  • Further study of these issues is warranted to verify these unusual findings.