A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer
<b>Background/Objectives</b>: Late toxicity following radiotherapy is common and compromises patient quality of life. However, the impact of toxicity on patient-reported outcome measures (PROMs) five years after prostate external beam radiotherapy (EBRT) is poorly characterised. We descr...
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2025-04-01
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| Series: | Société Internationale d’Urologie Journal |
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| author | Rowan V. David Peter L. Stapleton Arman A. Kahokehr Jason Lee David I. Watson John Leung Michael E. O’Callaghan |
| author_facet | Rowan V. David Peter L. Stapleton Arman A. Kahokehr Jason Lee David I. Watson John Leung Michael E. O’Callaghan |
| author_sort | Rowan V. David |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Late toxicity following radiotherapy is common and compromises patient quality of life. However, the impact of toxicity on patient-reported outcome measures (PROMs) five years after prostate external beam radiotherapy (EBRT) is poorly characterised. We describe PROMs using the Expanded Prostate Cancer Index Composite (EPIC-26) five years post-EBRT compared against radical prostatectomy (RP). <b>Methods</b>: A prospective cohort of patients with localised prostate cancer treated from 2000 to 2020 captured by a state-level cancer registry was analysed. Multivariable mixed-effects linear modelling was performed to compare differences between EPIC-26 domains over time between ERBT and RP patients. The percentage of patients recording a decline in EPIC-26 domains compared with baseline which exceeded the minimal clinically important difference (MCID) was calculated and compared between groups. Additionally, subgroup analysis was performed on patients treated using contemporary techniques. <b>Results</b>: There were 1720 patients (EBRT n = 1441 vs. RP n = 279) with evaluable EPIC-26 PROMS. Patients in the EBRT group had a higher median age (74 vs. 66, <i>p</i> < 0.001) and National comprehensive Cancer Network (NCCN) high-risk disease (61% vs. 24%, <i>p</i> < 0.001). Bowel domain scores were worse after EBRT compared to RP (beta −0.46, 95% CI −1.20–−0.28, <i>p</i> < 0.001), with a greater proportion of patients reporting a change in symptoms that exceeded the MICD at 12 months (22 vs. 11%, <i>p</i> = 0.009). Moderate/big bowel bother scores were significantly higher in the EBRT cohort at baseline and all follow-up periods compared to RP (beta −8.27, 95% CI −10.21–−6.34, <i>p</i> < 0.001). Pad use (i.e., ≥1) per day was significantly lower amongst the EBRT group (beta 16.56, 95% CI 14.35–18.76, <i>p</i> < 0.001). Despite contemporary techniques, EBRT was associated with worse bowel domain scores at 12 (75 vs. 80, <i>p</i> < 0.05) and 60 months (75 vs. 80, <i>p</i> < 0.05) compared to RP; however, EBRT was associated with less pad use at 12 (4% vs. 34%, <i>p</i> < 0.001), 24 (10% vs. 33%, <i>p</i> < 0.001) and 60 months (13% vs. 33%, <i>p</i> = 0.15) than RP. <b>Conclusions</b>: There are significant differences in PROMs after local curative treatment for prostate cancer which persist to five years post-treatment, despite contemporary techniques. Understanding the associated toxicity patterns helps inform shared decision-making during pre-treatment counselling. |
| format | Article |
| id | doaj-art-36698c50357c4d7da246095dfd94b782 |
| institution | DOAJ |
| issn | 2563-6499 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Société Internationale d’Urologie Journal |
| spelling | doaj-art-36698c50357c4d7da246095dfd94b7822025-08-20T03:13:48ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992025-04-01623510.3390/siuj6020035A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate CancerRowan V. David0Peter L. Stapleton1Arman A. Kahokehr2Jason Lee3David I. Watson4John Leung5Michael E. O’Callaghan6College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, AustraliaDepartment of Urology, Flinders Medical Centre, SA Health, Adelaide, SA 5042, AustraliaCollege of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, AustraliaCollege of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, AustraliaCollege of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, AustraliaCollege of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, AustraliaCollege of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia<b>Background/Objectives</b>: Late toxicity following radiotherapy is common and compromises patient quality of life. However, the impact of toxicity on patient-reported outcome measures (PROMs) five years after prostate external beam radiotherapy (EBRT) is poorly characterised. We describe PROMs using the Expanded Prostate Cancer Index Composite (EPIC-26) five years post-EBRT compared against radical prostatectomy (RP). <b>Methods</b>: A prospective cohort of patients with localised prostate cancer treated from 2000 to 2020 captured by a state-level cancer registry was analysed. Multivariable mixed-effects linear modelling was performed to compare differences between EPIC-26 domains over time between ERBT and RP patients. The percentage of patients recording a decline in EPIC-26 domains compared with baseline which exceeded the minimal clinically important difference (MCID) was calculated and compared between groups. Additionally, subgroup analysis was performed on patients treated using contemporary techniques. <b>Results</b>: There were 1720 patients (EBRT n = 1441 vs. RP n = 279) with evaluable EPIC-26 PROMS. Patients in the EBRT group had a higher median age (74 vs. 66, <i>p</i> < 0.001) and National comprehensive Cancer Network (NCCN) high-risk disease (61% vs. 24%, <i>p</i> < 0.001). Bowel domain scores were worse after EBRT compared to RP (beta −0.46, 95% CI −1.20–−0.28, <i>p</i> < 0.001), with a greater proportion of patients reporting a change in symptoms that exceeded the MICD at 12 months (22 vs. 11%, <i>p</i> = 0.009). Moderate/big bowel bother scores were significantly higher in the EBRT cohort at baseline and all follow-up periods compared to RP (beta −8.27, 95% CI −10.21–−6.34, <i>p</i> < 0.001). Pad use (i.e., ≥1) per day was significantly lower amongst the EBRT group (beta 16.56, 95% CI 14.35–18.76, <i>p</i> < 0.001). Despite contemporary techniques, EBRT was associated with worse bowel domain scores at 12 (75 vs. 80, <i>p</i> < 0.05) and 60 months (75 vs. 80, <i>p</i> < 0.05) compared to RP; however, EBRT was associated with less pad use at 12 (4% vs. 34%, <i>p</i> < 0.001), 24 (10% vs. 33%, <i>p</i> < 0.001) and 60 months (13% vs. 33%, <i>p</i> = 0.15) than RP. <b>Conclusions</b>: There are significant differences in PROMs after local curative treatment for prostate cancer which persist to five years post-treatment, despite contemporary techniques. Understanding the associated toxicity patterns helps inform shared decision-making during pre-treatment counselling.https://www.mdpi.com/2563-6499/6/2/35prostate cancerradiotherapyradical prostatectomypatient-reported outcome measuresEPIC-26quality of life |
| spellingShingle | Rowan V. David Peter L. Stapleton Arman A. Kahokehr Jason Lee David I. Watson John Leung Michael E. O’Callaghan A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer Société Internationale d’Urologie Journal prostate cancer radiotherapy radical prostatectomy patient-reported outcome measures EPIC-26 quality of life |
| title | A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer |
| title_full | A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer |
| title_fullStr | A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer |
| title_full_unstemmed | A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer |
| title_short | A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer |
| title_sort | 5 year follow up of patient reported outcome measures following external beam radiotherapy or radical prostatectomy in localised prostate cancer |
| topic | prostate cancer radiotherapy radical prostatectomy patient-reported outcome measures EPIC-26 quality of life |
| url | https://www.mdpi.com/2563-6499/6/2/35 |
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