Quality of life study in prostate cancer patients treated with three-dimensional conformal radiation therapy: Comparing late bowel and bladder quality of life symptoms to that of the normal population
Al. Hanlon et al., Quality of life study in prostate cancer patients treated with three-dimensional conformal radiation therapy: Comparing late bowel and bladder quality of life symptoms to that of the normal population, INT J RAD O, 49(1), 2001, pp. 51-59
Citations number
24
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Purpose: The goals of this study were twofold. First, differences were quan
tified for symptoms that impact bowel and bladder quality of life (QOL) in
prostate cancer patients treated with three-dimensional conformal radiother
apy (3DCRT) alone to the prostate vs. whole pelvis,vith prostate boost. Sec
ond, bowel and bladder QOL measures for these patients were compared to tho
se of the normal population of men with a similar age distribution.
Methods: Two health status surveys evaluating bowel and bladder functioning
, along with the AUA Symptom Problem Index and the BPH Impact Index, were m
ailed to 195 prostate cancer patients treated with 3DCRT between 12/92 and
11/95 at Fox Chase Cancer Center by a single clinician (GH). No patient rec
eived hormonal management as part of his treatment. Ninety-five patients ha
d pretreatment PSA levels <10 ng/ml, T1/T2A tumors with Gleason scores 2-6,
and no perineural invasion. They were treated to the prostate alone and ar
e referred to as Group I. The remaining 100 patients had one or more of the
following characteristics: pretreatment PSA levels <greater than or equal
to>10 ng/ml, T2B/T3 tumors, Gleason scores 7-10, or perineural invasion. Th
ese patients were treated to the whole pelvis followed by a boost to the pr
ostate and are referred to as Group II. Frequencies were tabulated, and dif
ferences in percentages for the two groups were evaluated using the two-tai
led Fisher's Exact Test. Overall percentages were compared to those for equ
ivalent measures reported by Litwin (1999) based on a normal population of
men with a mean age of 73 years (range 47-86). Comparisons to the normal po
pulation were also evaluated using two-tailed Fisher's Exact p values.
Results: The mailing yielded a high response rate of 71% (n = 139, 66 in Gr
oup I and 73 in Group IT). The mean age was 67 (range 49-82), and the media
n ICRU dose levels for Groups I and II were 73 and 76 Gy, respectively. Res
ponses relating to bladder symptoms were similar for Groups I and II, excep
t for the degree of bother associated with trouble in urination over the la
st month. Percentages for no bother at all were 66% and 56% for Groups I an
d II, respectively. Observed differences in bowel functioning related to re
ctal urgency over the past year (22% vs. 40% for Groups I and II, p = 0.03)
, the use of pads for protection against bowel incontinence (0% vs. 10% for
Groups I and IT, p = 0.01), and bowel satisfaction (88% vs. 72% for Groups
I and II, p = 0.03). There was no significant difference in the degree of
bother bladder symptoms cause men treated,vith radiotherapy as compared to
men without cancer. Few patients reported bowel dysfunction bother as a big
problem, but patients do tend to have more very small to moderate bother f
rom bowel dysfunction than the normal population (55% vs. 33%,p < 0.001).
Conclusions: This is the first long-term study of QOL in men treated with h
igh-dose 3DCRT for prostate cancer. It demonstrates that these men enjoy QO
L related to bladder function similar to that of the normal population. Few
patients report bother from bowel symptoms as a big problem but tend to ha
ve more very small to moderate bother than the normal population. Treatment
of prostate cancer patients to the whole pelvis may result in decreased QO
L as defined by rectal urgency, the use of pads for bowel incontinence, and
satisfaction with bowel functioning. However, regardless of field size, me
n are generally satisfied with their bowel and bladder functioning three to
six years post treatment. (C) 2001 Elsevier Science Inc.