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Multicenter Study
. 2024 Oct 1;7(10):e2440747.
doi: 10.1001/jamanetworkopen.2024.40747.

Postprostatectomy Radiotherapy Timing and Long-Term Health-Related Quality of Life

Sagar A Patel  1   2 , Dattatraya Patil  2 , Joseph Smith  3 , Christopher S Saigal  4 , Mark S Litwin  4 , Jim C Hu  5 , Matthew R Cooperberg  6 , Peter R Carroll  6 , Eric A Klein  7 , Adam S Kibel  8 , Gerald L Andriole  9 , Misop Han  9 , Jeff M Michalski  10 , David P Wood  11 , Larry A Hembroff  12 , Daniel E Spratt  13 , John T Wei  14 , Howard M Sandler  15 , Daniel A Hamstra  16 , Louis Pisters  17 , Deborah Kuban  18 , Meredith M Regan  19 , Andrew Wagner  20 , Catrina M Crociani  20 , Irving Kaplan  21 , Martin G Sanda  2 , Peter Chang  20 ; PROST-QA/RP2 Consortium
Collaborators, Affiliations
Multicenter Study

Postprostatectomy Radiotherapy Timing and Long-Term Health-Related Quality of Life

Sagar A Patel et al. JAMA Netw Open. .

Abstract

Importance: The association between radiotherapy (RT) timing after radical prostatectomy and long-term patient-reported health-related quality of life (HRQOL) in men with prostate cancer is unknown.

Objective: To measure long-term HRQOL in men with prostate cancer up to 15 years after prostatectomy with or without RT and examine whether early vs late postprostatectomy RT is associated with differences in sexual, urinary, and bowel HRQOL.

Design, setting, and participants: A prospective, multicenter, longitudinal cohort analysis using HRQOL data from the PROST-QA (2003-2006) and RP2 consortium (2010-2013) studies was conducted. Men with localized prostate cancer undergoing radical prostatectomy were included. Data were analyzed between May 8, 2023, and March 1, 2024. The study was conducted in 12 high-volume academic medical centers in the US.

Exposures: Men were stratified based on receipt and timing of postprostatectomy RT: prostatectomy only, early RT (<12 months), and late RT (≥12 months).

Main outcomes and measures: Longitudinal sexual, incontinence, urinary irritation, bowel, and hormonal/vitality HRQOL were measured via the Expanded Prostate Cancer Index Composite at baseline; months 2, 6, and 12; and annually thereafter. Treatment groups were compared using multivariable linear mixed-effects models of change in longitudinal domain scores. Pad use for incontinence was measured longitudinally among men receiving postprostatectomy RT.

Results: A total of 1203 men were included in the study: prostatectomy only (n = 1082), early RT (n = 57), and late RT (n = 64). Median age for the entire cohort was 60.5 (range, 38.8-79.7) years, and 1075 men (92.0%) were White. Median follow-up was 85.6 (IQR, 35.8-117.2) months. Compared with men receiving prostatectomy alone, those receiving postprostatectomy RT had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL. However, timing of postprostatectomy RT, specifically early vs late, was not associated with a long-term decrease in any HRQOL domain. There was evidence of improved recovery of sexual, continence, and urinary irritation scores among men receiving early RT compared with those receiving late RT after prostatectomy. Before the start of postprostatectomy RT, 39.3% of men in the early RT cohort and 73.4% of men in the late RT cohort were pad-free. By the sixth visit post-RT, 67.4% in the early RT cohort and 47.6% in the late RT cohort were pad-free.

Conclusions and relevance: In this multicenter, prospective analysis, postprostatectomy RT appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy RT may result in similar long-term HRQOL outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kibel reported receiving advisory board fees from Profound, Janssen, and Pfizer, and data safety and monitoring board fees from Bristol Myers Squibb outside the submitted work. Dr Spratt reported receiving personal fees from Astellas, AstraZeneca, Bayer, Boston Scientific, Janssen, Novartis, and Pfizer outside the submitted work. Dr Wei reported receiving grants from the National Cancer Institute during the conduct of the study. Dr Sandler reported being an unpaid board of directors member of ASTRO. Dr Hamstra reported receiving personal fees from Boston Scientific outside the submitted work. Dr Regan reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study; and grants from Bayer, Biotheranostics, Bristol-Myers Squibb, Novartis, Pfizer, Roche, and TerSera; personal fees from Bristol-Myers Squibb, TerSera, and Tolmar; and nonfinancial support from Merck outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Eligible PROST-QA (PQA) and PROSTQA-RP2 (RP2) Comparative Groups
RP indicates radical prostatectomy; RT, radiotherapy (early, <12 months after radical prostatectomy; late, ≥12 months after radical prostatectomy).
Figure 2.
Figure 2.. Quality of Life Over Time Among Men Receiving Prostatectomy Alone, Prostatectomy Plus Early Radiation Therapy (RT), or Prostatectomy Plus Late RT
The curves show the median; error bars indicate IQRs. Early RT, less than 12 months after radical prostatectomy; late RT, 12 months or more after radical prostatectomy.
Figure 3.
Figure 3.. Quality of Life Over Time Centered Around the Time of Radiation Therapy (RT) Among Men Receiving Early vs Late Postprostatectomy RT
Error bars indicate IQR. Early RT, less than 12 months after radical prostatectomy; late RT, 12 months or more after radical prostatectomy.
See this image and copyright information in PMC

References

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