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

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.