Timing of Radiotherapy after Radical Prostatectomy: Effects on Health-Related Quality of Life

No AccessJournal of UrologyAdult Urology1 Nov 2021Timing of Radiotherapy after Radical Prostatectomy: Effects on Health-Related Quality of Life Thilo Westhofen, Alexander Buchner, Boris Schlenker, Armin Becker, Minglun Li, Claus Belka, Christian G. Stief, Nina-Sophie Schmidt-Hegemann, and Alexander Kretschmer Thilo WesthofenThilo Westhofen Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author , Alexander BuchnerAlexander Buchner Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author , Boris SchlenkerBoris Schlenker Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author , Armin BeckerArmin Becker Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author , Minglun LiMinglun Li Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author , Claus BelkaClaus Belka Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany Financial and/or other relationship with Viewray, C-Rad, Brainlab, Elekta, MERCK, BMS and AstraZeneca. More articles by this author , Christian G. StiefChristian G. Stief Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author , Nina-Sophie Schmidt-HegemannNina-Sophie Schmidt-Hegemann Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany Equally study contribution. More articles by this author , and Alexander KretschmerAlexander Kretschmer ‡Correspondence: Urology, Ludwig-Maximilians-University—Department of Urology, Marchioninistrasse 15, 81377Munich, Germany telephone: +4989-4400-0; FAX: +49894400-75444; E-mail Address: [email protected] Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany Equally study contribution. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001930AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The optimal timing of radiotherapy (RT) after radical prostatectomy (RP) remains controversial with unknown impact on health-related quality of life (HRQOL). We aimed to compare the influence of early RT (eRT) and deferred RT (dRT) on HRQOL. Materials and Methods: A total of 4,511 patients were analyzed. Inclusion criteria encompassed: ≥pT3, International Society of Urological Pathology grade ≥4, or positive surgical margin. A 1:4 propensity score-matched-analysis of 1,599 patients was conducted (307: eRT, ≤6 months after RP; 1,292: dRT, >6 months after RP). Primary end point was general HRQOL (based on European Organisation for Research and Treatment of Cancer QLQ-C30). Pearson correlation and binary logistic regression models were used to estimate the impact of timing of RT on HRQOL. Functional outcome was assessed using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires. Results: Median followup was 38 months. At 12 months and 24 months followup, general HRQOL scores were significantly higher for dRT (52.7 vs 35.5; p=0.001; 45.8 vs 37.3; p=0.026). ICIQ-SF scores were higher (8.5 vs 6.1; p=0.001; 8.4 vs 7.3; p=0.038), and IIEF-5 scores were lower (1.8 vs 4.2; p=0.001; 2.2 vs 4.4; p=0.005) for eRT at 12 months and 24 months. On multivariate-analysis, dRT was associated with superior general HRQOL at 12 months (OR 0.59, 95% CI 0.37–0.94, p=0.027) and 24 months (OR 0.64, 95% CI 0.39–0.99, p=0.043), respectively. A longer time interval between RP and RT was associated with improved general HRQOL (OR 1.09, 95% CI 1.038–1.143; p <0.001). Conclusions: dRT yields improved short-term HRQOL compared to eRT. Since longer time intervals between RP and RT predict better short-term HRQOL, our data provide further support for the concept of deferred RT at low prostate specific antigen recurrence. References 1. : Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev 2020; 6: Cd006590. Google Scholar 2. : Epidemiology of radical prostatectomy for localized prostate cancer in the era of prostate-specific antigen: an overview of the Department of Defense Center for Prostate Disease Research national database. Surgery 2002; 132: 213. Google Scholar 3. : Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 2006; 98: 715. Google Scholar 4. : Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis. 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Ethical approval: This study was performed according to the 1964 Helsinki Declaration and was approved by an institutional ethics committee. Informed consent was obtained from all individuals participating in the study. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 5, (1083-1084), Online publication date: 1-Nov-2021. Volume 206Issue 5November 2021Page: 1192-1203 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsradiotherapy, adjuvantquality of lifeprostatectomyprostatic neoplasmsMetricsAuthor Information Thilo Westhofen Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author Alexander Buchner Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author Boris Schlenker Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author Armin Becker Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author Minglun Li Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author Claus Belka Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany Financial and/or other relationship with Viewray, C-Rad, Brainlab, Elekta, MERCK, BMS and AstraZeneca. More articles by this author Christian G. Stief Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany More articles by this author Nina-Sophie Schmidt-Hegemann Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany Equally study contribution. More articles by this author Alexander Kretschmer Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany ‡Correspondence: Urology, Ludwig-Maximilians-University—Department of Urology, Marchioninistrasse 15, 81377Munich, Germany telephone: +4989-4400-0; FAX: +49894400-75444; E-mail Address: [email protected] Equally study contribution. More articles by this author Expand All Author contributions: Thilo Westhofen: study design, data collection, data analysis and manuscript writing/editing. Alexander Buchner: data collection and manuscript editing. Boris Schlenker: data collection and manuscript editing. Armin Becker: data collection and manuscript editing. Minglun Li: manuscript editing. Claus Belka: manuscript editing. Christian G. Stief: protocol/project development, data analysis, coordination of study and manuscript editing. Nina-Sophie Schmidt-Hegemann: study design, data collection, data analysis and manuscript writing/editing. Alexander Kretschmer: study design, data collection, data analysis and manuscript writing/editing. Ethical approval: This study was performed according to the 1964 Helsinki Declaration and was approved by an institutional ethics committee. Informed consent was obtained from all individuals participating in the study. Advertisement PDF downloadLoading ...