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
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
- 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
- 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.
- 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.