Longitudinal change in health-related quality of life after intensity-modulated radiation monotherapy for clinically localized prostate cancer

Abstract

Purpose: The purpose of the study is to assess longitudinal changes in general and disease-specific health-related quality-of-life (HRQOL) indices after intensity-modulated radiotherapy (IMRT) monotherapy for patients with localized prostate cancer (PCA).

Methods: Between 2006 and 2010, 91 patients with localized PCA underwent IMRT monotherapy and were enrolled into this prospective study. At baseline, and at 3, 6, 12, and 24 months after IMRT, the general and prostate-specific HRQOL were estimated using physical (PCS) and mental component summaries (MCS) calculated using the Medical Outcomes Study 8-Item Short Form Health Survey and Expanded Prostate Cancer Index Composite (EPIC).

Results: For 2 years, there were no significant changes in EPIC scores in all subscales of urinary domain, hormonal function, and bother. Bowel and sexual function scores decreased after IMRT and did not return to those at baseline (p = 0.006 and < 0.001, respectively). PCS began to decrease at 3 months after IMRT and then returned to the baseline score at 24 months. In contrast, the MCS score began to significantly increase after IMRT, and thereafter the score remained constant until 24 months (p < 0.001). On multivariate logistic regression analysis, urinary (p = 0.003) and sexual functions (p = 0.0005) at baseline were identified as significant predictors of EPIC urinary irritative/obstructive score and sexual function at 24 months after IMRT.

Conclusion: Urinary function, including irritative/obstruction symptoms and hormonal function, was not affected by IMRT. However, bowel and sexual function decreased after IMRT. These findings will provide important information for PCA patients considering IMRT.

Fig. 1

Longitudinal changes in domain and subdomain scores of the EPIC and scores of SF-8 (PCS and MCS) in patients treated with IMRT. High scores indicate better outcomes. a Urinary function, b urinary bother, c incontinence, d irritative/obstructive, e bowel function, f bowel bother, g sexual function, h sexual bother, i hormonal function, j hormonal bother, k PCS, and MCS

Fig. 1

Longitudinal changes in domain and subdomain scores of the EPIC and scores of SF-8 (PCS and MCS) in patients treated with IMRT. High scores indicate better outcomes. a Urinary function, b urinary bother, c incontinence, d irritative/obstructive, e bowel function, f bowel bother, g sexual function, h sexual bother, i hormonal function, j hormonal bother, k PCS, and MCS

Fig. 2

Longitudinal changes in urinary subscales of the EPIC according to pretreatment urinary function. High scores indicate better functional outcomes. Baseline means pretreatment state. Good and poor urinary functions are defined as < 8 points and 8 or more points of pretreatment IPSS score, respectively. a urinary function, b urinary bother, c incontinence, and d irritative/obstructive

Fig. 3

Longitudinal changes in sexual function and bother scores of the EPIC in patients with potency at baseline. High scores indicate better outcomes (sexual function: solid line; sexual bother: dotted line)