External Beam Radiation Therapy or Brachytherapy With or Without Short Course Neoadjuvant Androgen Deprivation Therapy: Results of a Multi-Center, Prospective Study of Quality of Life

Publication date: Available online 22 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Hiram Alberto Gay, Martin G. Sanda, Jingxia Liu, Ningying Wu, Daniel A. Hamstra, John T. Wei, Rodney L. Dunn, Eric A. Klein, Howard M. Sandler, Christopher S. Saigal, Mark S. Litwin, Deborah A. Kuban, Larry Hembroff, Meredith M. Regan, Peter Chang, Jeff M. Michalski
PurposeThe long-term effects of neoadjuvant androgen deprivation therapy (NADT) with radiation therapy on participant-reported health-related quality of life (HRQOL) have not been characterized in prospective multi-center studies. We evaluated HRQOL for 2 years among participants undergoing radiation therapy (RT) with or without NADT for newly diagnosed, early-stage prostate cancer.MethodsWe analyzed longitudinal cohort data from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium to ascertain the HRQOL trajectory of men receiving NADT with external beam radiation therapy (EBRT) or brachytherapy (BT). HRQOL was measured with the EPIC-26 questionnaire at 2, 6, 12, and 24 months after the initiation of NADT. We used Chi-square or Fisher's Exact test to compare the shift percentages between groups that did or did not receive NADT. Analyses were conducted at the two-sided 5% significance level.ResultsFor subjects receiving EBRT, questions regarding the ability to have an erection, ability to reach an orgasm, quality of erections, frequency of erections, ability to function sexually, and lack of energy were in a significantly worse dichotomized category for the patients receiving NADT. Comparing baseline versus 24 months, 24%, 23%, and 30% of participants receiving EBRT plus NADT shifted to the worse dichotomized category for the ability to reach an orgasm, quality of erections, and ability to function sexually compared to 14%, 13% and 16% in the EBRT group, respectively.ConclusionCompared to baseline, at 2 years participants receiving NADT plus EBRT compared with EBRT alone had worse HRQOL, as measured by the ability to reach orgasms, quality of erections, and ability to function sexually. However, there was no difference in the ability to have an erection, frequency of erections, overall sexual function, hot flashes, breast tenderness/enlargement, feeling depressed, lack of energy or change in body weight. The improved survival in intermediate and high-risk patients receiving ADT and EBRT necessitates pre-treatment counseling of the HRQOL impact of ADT and EBRT.

Teaser

We evaluated HRQOL for 2 years among 573 participants undergoing EBRT or BT with or without NADT for newly diagnosed, early-stage prostate cancer. At 2 years, participants receiving NADT plus EBRT compared to EBRT had a worse ability to reach an orgasm, erection quality, and ability to function sexually, while the ability to have an erection, frequency of erections, sexual function, hot flashes, breast tenderness, feeling depressed, lack of energy, and body weight did not reach significance.


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