Randomized Trial Of External Beam Radiotherapy Versus Cryoablation In Patients With Localized Prostate Cancer: Quality Of Life Outcomes

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 26 Oct 2009 - 3:00 PDT

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UroToday.com - In the online edition of Cancer, Dr. John Robinson and associates present QoL outcomes from a single institution randomized trial comparing external beam radiotherapy (EBRT) with cryotherapy for localized prostate cancer (CaP). They previously reported a non-inferiority oncologic outcome for cryotherapy in this study.

The trial ran from 1997 to 2003, and 122 CaP patients were randomized to EBRT and 122 to cryotherapy. Neoadjuvant hormone therapy was given for 3 months in 160 patients and 6 months in 71 patients. QoL was assessed by the EORTC QLO C30 and the UCLA Prostate Cancer Index prior to treatment and at 1.5, 3, 6, 13, 24, and 36 months after treatment. Domains assessed in the EORTC QLO C30 include physical activity, emotional state, social interaction, global health, and symptom scales. The UCLA Prostate Cancer Index assesses sexual, urinary, and bowel functions.

EORTC QLO C30 domains demonstrated an increase in symptoms after either treatment with the exception of insomnia and more EBRT patients experienced insomnia at 3 and 24 months compared with cryotherapy patients. The average urinary bowel and sexual function scores demonstrated differences. Cryoablation patients reported lower urinary function scores (69.4 vs. 90.7), similar bowel function, and lower sexual function scores (7.2 vs. 32.9). At 36 months EBRT men had slightly lower urinary function scores but no difference in bowel function scores. The cryoablation patients had lower sexual function scores at 36 months (16 vs. 36.7). The proportion of cryotherapy patients with urinary bother increased from 1% at baseline to 29.3% at 6 weeks with no long-term effects at 36 months. Bowel bother for EBRT patients increased from 2.6% at baseline to 10.3% at 36 months and moderate to severe sexual problems increased from 12.5% in both groups at baseline to 53% and 34% in the cryoablation and EBRT groups, respectively.

At baseline, 113 men reported being potent, and 62% in the cryoablation arm and 55% in the EBRT arm were having unassisted intercourse at that time. At 36 months this had decreased to 22% in the cryoablation arm and 36% in the EBRT group. Overall men treated with EBRT had better sexual function following treatment.

Robinson JW, Donnelly BJ, Siever JE, Saliken JC, Ernst SD, Rewcastle JC, Trpkov K, Lau H, Scott C, Thomas B
Cancer. 2009 Aug 18. Epub ahead of print.
doi:10.1002/cncr.24523
Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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