SEQUELAE OF DEFINITIVE RADIATION-THERAPY FOR PROSTATE-CANCER LOCALIZED TO THE PELVIS

Objectives. To evaluate sequelae and estimate quality of life utilizin g a survey instrument in 133 consecutive patients who have undergone d efinitive radiation therapy for localized prostate cancer. Methods. Al l patients reported on have been followed for 14 to 60 months (median, 31 months) after radiation therapy and only patients with definitive prostate radiation therapy are included. Of the patients still alive a t time of follow-up, 115 were mailed the questionnaire. Data regarding tumor grade and stage as well as treatment were extracted from patien t files. Results. Of the 91% of patients who returned the questionnair e, 11% used a pad and 13% leaked more than a few drops of urine daily. Of all the respondents, 9% stated that incontinence was a problem, an d 31% found urinary leaking significantly worsened after radiation the rapy compared with before their diagnosis of prostate cancer. With res pect to sexual function, 77% recalled being able to have full or parti al erections prior to radiation therapy. At some time after radiation therapy, 22% of previously potent respondents were able to have a full erection and 41% were able to have a partial erection. Twenty-nine pe rcent of all patients who were able to establish an erection prior to radiation therapy reported that impotence was a problem at the time of follow-up. Forty-nine percent of patients had abdominal pain, diarrhe a, or abdominal cramping during or after radiation therapy and 31% of all patients still had some intestinal symptoms at the time of followu p. Eighteen percent of all patients were significantly bothered by one or more of these bowel problems. Overall, 31% of all patients reporte d a persistent degree of physical discomfort that they believed was se condary to their prostate cancer or the effect of treatment. Eighty-on e percent were satisfied with radiation therapy and 97% of the patient s said they would have radiation therapy again if faced with the decis ion. Conclusions. Utilizing a sensitive questionnaire on patients who had definitive radiation therapy for prostate cancer, we found the inc idence of patients bothered by incontinence to be surprisingly frequen t and higher than previously reported. The frequency of impotence is s imilar to previous studies. However, when our incontinence and impoten ce data were compared to Medicare patients who had undergone radical p rostatectomy, the frequencies after radiation therapy were significant ly lower. Despite the rates of sequelae, the patients were generally s atisfied with the decision to undergo radiation therapy and with the m edical treatment received.