Long-term rectal function after permanent prostate brachytherapy.
OBJECTIVE
To evaluate the effect of prostate brachytherapy with or without supplemental therapies on long-term rectal function by means of a patient-administered quality-of-life instrument.


METHODS
As part of an ongoing prospective evaluation, 164 of an initial 209 patients who remain alive were mailed the Rectal Function Assessment Score (R-FAS) with a prestamped return envelope. R-FAS range from 0 to 27 with lower scores being indicative of better bowel function. Of the 162 eligible patients, 161 (99.4%) returned the survey. Median follow-up was 9.0 years (range 8.2-11.2 years). Clinical, treatment, and dosimetric parameters evaluated for bowel function included patient age, diabetes, hypertension, tobacco consumption, clinical T stage, elapsed time since brachytherapy, ultrasound volume, planning target volume, androgen deprivation therapy, supplemental external beam radiation, isotope, rectal dose, prostate D100/D150/D200, and prostate D90.


RESULTS
For the entire cohort, the current R-FAS was 3.59, which represented a nonstatistical improvement from prior surveys in 1999 (4.29) and 2002 (3.92) (P=0.134). Only 16 patients (9.9%) reported bowel function to be worse after brachytherapy. Of the clinical, treatment, and dosimetric parameters evaluated, only the number of preimplant bowel movements, tobacco use, and diabetes correlated with R-FAS. Despite lower rectal doses with Pd, isotope did not predict for bowel function. Consistent with prior surveys, patient perception of overall rectal quality of life was inversely related to supplemental external beam radiation (P=0.027).


CONCLUSIONS
Prostate brachytherapy adversely affects bowel function. However, in most patients the changes are minimal and slowly resolve with time. Overall rectal quality of life is inversely related to supplemental external beam radiation.
Merrick
Gregory S
GS
Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV 26003-6300, USA. gmerrick@urologicresearchinstitute.org
Butler
Wayne M
WM
Wallner
Kent E
KE
Galbreath
Robert W
RW
Allen
Zachariah A
ZA
Gutman
Sarah
S
Lief
Jonathan
J
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D003672:Defecation / Q000528:radiation effects*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D012002:Rectal Diseases / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires