THE EFFECT OF SALVAGE RADIOTHERAPY AND ITS TIMING ON THE HEALTH-RELATED QUALITY OF LIFE OF PROSTATE CANCER PATIENTS
Salvage radiotherapy (SRT) can be offered to men with prostate cancer who evidence rising PSA levels after radical prostatectomy (RP). Although SRT may achieve biochemical responses, there is no level 1 evidence that shows a survival benefit. The purpose of this study is to describe the impact of SRT on health-related quality of life (HRQoL), and to investigate whether SRT timing (time between RP and SRT) is associated with HRQoL outcomes.
All SRT patients (n=241) and all RP-only patients (n=1005) were selected from a prospective database (2004-2015) of the Antoni van Leeuwenhoek hospital in Amsterdam, the Netherlands. The database contains HRQoL and prostate problem assessments up to two years after last treatment (Figure 1). Mixed effects growth modelling adjusting for significant differences in patient characteristics and baseline HRQoL was used to analyse the association between: (1) ‘treatment' (RP-only vs SRT) and (2) ‘timing of SRT' with changes in HRQoL.
(1) SRT patients showed significantly (p<0.05) poorer recovery from urinary, bowel, and erectile function after their last treatment than RP-only patients (clinically meaningful differences for urinary and erectile function). (2) Patients with a longer interval (≥7months) between RP and SRT reported significantly better sexual satisfaction after SRT (p=0.02), and a better recovery of urinary function (p=0.03).
Up to two years after treatment, SRT patients reported poorer HRQoL in several HRQoL domains as compared to RP-only patients, but not in overall HRQoL. Delaying the start of SRT after RP may limit the incidence and duration of urinary and sexual problems. Nevertheless, decisions regarding SRT timing should also be based on the potential benefits in terms of disease recurrence.
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