Long-Term Health-Related Quality-of-Life Outcomes after Permanent Prostate Brachytherapy

Abstract

Background: We evaluated the long-term health-related quality of life (HRQoL) after modern prostate brachytherapy (PB). Patients and Methods: The European Organization for Research and Treatment of Cancer (EORTC) prostate cancer quality-of-life questionnaire, QLQ-PR25, and the modified International Continence Society (ICS) male questionnaire were sent to 296 men treated with PB at the University Medical Center Mannheim. To evaluate the influence of age, we subclassified two groups: group 1 <65 years, group 2 ≧65 years. 258 of the 296 patients were alive at the time of assessment. Of 238 questionnaires (92% response rate), 231 were suitable for analysis. Median follow-up was 51 months. Results: Of group 1 77.8% and of group 2 73.4% of the men were in good, very good or excellent health. There was a low rate of moderate (10.4%) or strong (1.0%) symptoms regarding urinary functioning. Stress incontinence was uncommon. Only 28.2% reported moderate or strong (up to 17.6%) symptoms regarding sexual functioning. In group 1 48.6% and in group 2 25.0% of patients reported no or minor erectile dysfunction (p < 0.007). There was no severe overall rectal dysfunction (<2%). Conclusion: Our data substantiate the favorable long-term HRQoL outcomes associated with modern PB techniques. Significant age differences were observed in sexual symptoms and less pronounced age differences in urinary symptoms. We found a low rate of urinary symptoms and no evidence of severe rectal dysfunction.

Long‐term toxicity and quality of life up to 10 years after low‐dose rate brachytherapy for prostate cancer

“…Nevertheless, bowel toxicity at follow‐up was low: only 2.9% of patients reported moderate bowel toxicity and none reported severe toxicity. These findings are consistent with those of previous studies [21,23,26–28,32].…”

“…In view of that equivalence, post‐treatment QoL secondary to urinary symptoms, maintenance of sexual function and normal bowel function are becoming increasingly important to both physicians and patients when deciding which modality is probably the most suitable. Several studies have reported toxicity outcomes within the first few years after treatment [11,15–27] but there have been fewer longer‐term studies of those considerations [3,28–33]. In the present study, we assessed various aspects of QoL and sexual function up to 10 years after prostate BXT, with a good response rate to the request for follow‐up information (77%).…”

“…In another study, Schafer et al . [26] found that, after a median follow‐up of 51 months post‐BXT, only 10.4% and 1% of men reported moderate or severe urinary symptoms, respectively. It is possible that the less favourable urinary morbidity at follow‐up in the cohort of men in the present study is a consequence of the increased duration of follow‐up (up to 124 months), namely the effect of age [34] and the possibility that any long‐standing mild obstruction would upgrade the patient symptom score into the moderate category.…”

Outcomes of Gleason Score ≤8 among High Risk Prostate Cancer Treated with125I Low Dose Rate Brachytherapy Based Multimodal Therapy

“…Schafer, et al28 showed that only 10.4% and 1% of men reported moderate and severe urinary symptoms, respectively, whereas Koontz, et al29 reported that acute GU toxicity and GI toxicity occurred in approximately 80% and 24% of patients, respectively, and that late GU toxicity and GI toxicity occurred in 21% and 38% of patients, respectively. In our series, late GU toxicity was observed in nearly 96% of all patients, but 65% of them were classified as RTOG toxicity grade <3, which was controlled by medication.…”

The German S3 Guideline Prostate Cancer

“…Randomized trials comparing the different therapeutic concepts do not exist, but there are large cohort studies with PSA-free survival rates comparable to a treatment with radical prostatectomy or external-beam radiotherapy [27,30,36] and low toxicity rates [26]. The prescribed dose for LDR brachytherapy with iodine-125 ( 125 I) seeds is 145 Gy.…”