External beam radiotherapy of prostate cancer with or without high dose-rate brachytherapy: the Norwegian experience with long-term urinary and bowel adverse effects.

BACKGROUND: There are few studies utilizing the Expanded Prostate Index Composite questionnaire-26 (EPIC-26) questionnaire to examine the long-term association between Domain Summary Scores (DSSs) and Quality of Life (QoL) after External Beam Radiation Therapy (EBRT, 3DCRT [3D conventional radiotherapy]/IMRT [intensity modulated radiation therapy]) versus EBRT combined with High-Dose-Rate Brachytherapy (BT+, 3DCRT [3D conventional radiotherapy]/IMRT). In this cross-sectional study we compare long-term adverse effects and QoL after BT+ with EBRT. METHODS: Prostate Cancer Survivors who at least 5 years previously, had undergone BT+ at Oslo University Hospital between 2004 and 2010 (n = 259) or EBRT (multicentre cohort) between 2009 and 2010 (n = 99) completed a questionnaire containing EPIC-26, Short Form-12 and questions regarding comorbidity/social status. Results were presented as DSSs and Physical/Mental Composite Scores of QoL (PCS/MCS). Regression analyses explored firstly the associations between treatment modality and DSSs and secondly the impact of DSSs on QoL. We estimated the proportions of patients with big/moderate problems. Clinical relevance was set according to the lowest limit of published Minimal Important Differences. P-values <0.05 were considered statistically significant. RESULTS: In multivariate analysis, only the urinary incontinence DSS remained statistically (P < 0.05) and clinically significantly greater after BT+ than EBRT (90 vs. 83). The number of men with moderate/big urinary or bowel problems was halved after BT+ (P < 0.05). The number of patients with impaired PCS (score < 45) were lower in the BT+ group than the EBRT group (P = 0.02). Regression analysis showed that decreasing levels of bowel and urinary irritation/obstructive DSSs predicted worsening of PCS (P < 0.001) and MCS (P = 0.007), respectively. CONCLUSIONS: Dose-escalated radiotherapy by BT did not negatively impact long-term adverse effects, substantial problems or QoL compared with EBRT. Future randomised studies using improved EBRT techniques are needed.

Pre- and post-prostatectomy variables associated with pelvic post-operative radiotherapy in prostate cancer patients: a national registry-based study.

BACKGROUND: In patients with prostate cancer (PCa), the lack of clear guidelines on the use of radiotherapy after radical prostatectomy (RP) invites unwanted variation of this treatment. We describe the hazard ratios and probabilities related to the use of post-RP radiotherapy. MATERIAL AND METHODS: Data were collected from the Cancer Registry of Norway and nine radiotherapy units. All patients were diagnosed with a non-metastatic PCa from January 2004 through June 2011. Adjuvant radiotherapy was defined as pelvic radiotherapy initiated <5 months after RP at a PSA <0.2 ng/ml. All other pelvic radiotherapy series were categorized as salvage radiotherapy, and, combined with adjuvant radiotherapy they were termed post-RP radiotherapy. RESULTS: Of 6840 prostatectomized patients, 1170 (17%) had undergone post-RP radiotherapy, mainly as salvage radiotherapy. The number of adjuvant radiotherapy series almost tripled from 2009. Based on pre-prostatectomy variables (PSA, Gleason score, and clinical risk group) and findings in the prostatectomy specimens (status of resection margins, pathological tumor category and Gleason's score), the probability of post-RP radiotherapy ranged respectively from 14% to 73%, and from 4% to 83%. CONCLUSIONS: In our study, post-RP radiotherapy was applied in approximately one in six patients. Based on the combination of PCa-specific variables routinely available at the time of diagnosis, a patient's probability of post-RP radiotherapy can be determined before decision of primary treatment strategy, followed by probability determination based on histopathological variables emerging from the prostatectomy specimen.