UROLOGICAL ONCOLOGY

Health related quality of life patterns in patients treated with interstitial prostate brachytherapy for localized prostate cancer—data from CaPSURE
Downs TM, Sadetsky N, Pasta DJ, Grossfeld GD, Kane CJ, Mehta SS, Carroll PR, Lubeck DP
Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, UCSF/Mt. Zion Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
J Urol. 2003; 170: 1822-7

• Purpose: We measured the impact brachytherapy monotherapy (BMT) has on general and disease specific health related quality of life (HRQOL) compared to patients treated with radical prostatectomy (RP).
• Materials and Methods: We studied 419 men with newly diagnosed prostate cancer who enrolled in CaPSURE (Cancer of the Prostate Strategic Urological Research Endeavor) database whose primary treatment was brachytherapy monotherapy (92) or radical prostatectomy (327). The validated RAND 36-Item Health Survey and the UCLA Prostate Cancer Index were used to measure HRQOL before treatment and at 6-month intervals during the first 2 years after treatment.
• Results: Patients treated with BMT or RP did not differ greatly in general HRQOL after treatment. Both treatment groups showed early functional impairment in most general domains with scores returning to or approaching baseline in most domains 18 to 24 months after treatment. Patients treated with BMT had significantly higher urinary function scores at 0 to 6 months after treatment (84.5, SD 18.7) than patients treated with RP (63.3, SD 26.6). Urinary bother scores at 0 to 6 months after treatment were not significantly different between patients treated with BMT (67.7, SD 31.2) and those treated with RP (67.4, SD 29.1). Both treatment groups had decreases in sexual function that did not return to pretreatment levels.
• Conclusions: Overall BMT and RP are well tolerated procedures that cause mild changes in general HRQOL. Disease specific HRQOL patterns are different in patients treated with BMT or RP. Baseline and serial HRQOL measurements after treatment can provide valuable information regarding expected quality of life outcome after treatment for localized prostate cancer.
  
  
• Editorial Comment
  This paper nicely reflects the clinically well known pattern of side effects of interstitial brachytherapy in relation to radical prostatectomy. Patients treated with radical prostatectomy had urinary function change scores greater than 15 points below baseline at all time intervals after treatment, when differences of 5-10 points are thought to represent a clinically significant change. The worst change score difference was 0-6 months after treatment (28.8 points below base line values). Significant change score differences between the two groups of patients were detected at all time intervals after treatment (p < 0.003). With brachytherapy, significant bowel function change score differences were detected 0-12 month after treatment (3.8 – 13.6 points below baseline values). By 18 months after treatment, no significant change score difference was detected in patients with brachytherapy.
  Significant group change score differences were detected at each time interval for both sexual domains, namely sexual function and bother (p < 0.02). Bowel impairment differences between patients treated with brachytherapy or radical operative therapy were evident after the first post treatment evaluations only.
  In summary, these data clearly show the advantage, at least on a short term basis within the first 2 years, with regard to side effects of brachytherapy over radical prostatectomy. With the good long-term results available now in the literature with regard to the therapeutic outcome, brachytherapy indeed represents a valuable alternative of treatment for localized prostate cancer.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany