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Open Access Highly Accessed Research

Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer

Alan Katz1*, Montserrat Ferrer234, José Francisco Suárez5 and Multicentric Spanish Group of Clinically Localized Prostate Cancer

Author Affiliations

1 Flushing Radiation Oncology, 4022 Main St # 3, Flushing, NY, 11354, USA

2 Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain

3 CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

4 Universitat Autònoma de Barcelona, Bellaterra, Spain

5 Servicio de Urología, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

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Radiation Oncology 2012, 7:194  doi:10.1186/1748-717X-7-194

Published: 20 November 2012

Abstract

Background

As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument.

Methods

Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL.

Results

The largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients.

Conclusions

Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.

Keywords:
Prostate cancer; Prostatectomy; Quality of life; Stereotactic body radiotherapy