[Quality of life after radiotherapy for prostate cancer]

Abstract

The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormonotherapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormonotherapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormonotherapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormonotherapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up.