Toxicity profile with a large prostate volume after external beam radiotherapy for localized prostate cancer.
OBJECTIVE
To assess the impact of prostate volume on health-related quality of life (HRQOL) before and at different intervals after radiotherapy for prostate cancer.


METHODS
A group of 204 patients was surveyed prospectively before (Time A), at the last day (Time B), 2 months after (Time C), and 16 months (median) after (Time D) radiotherapy, with a validated questionnaire (Expanded Prostate Cancer Index Composite). The group was divided into subgroups with a small (11-43 cm(3)) and a large (44-151 cm(3)) prostate volume.


RESULTS
Patients with large prostates presented with lower urinary bother scores (median 79 vs. 89; p = 0.01) before treatment. Urinary function/bother scores for patients with large prostates decreased significantly compared to patients with small prostates due to irritative/obstructive symptoms only at Time B (pain with urination more than once daily in 48% vs. 18%; p < 0.01). Health-related quality of life did not differ significantly between both patient groups at Times C and D. In contrast to a large prostate, a small initial bladder volume (with associated higher dose-volume load) was predictive for lower urinary bother scores both in the acute and late phase; at Time B it predisposed for pollakiuria but not for pain. Patients with neoadjuvant hormonal therapy reached significantly lower HRQOL scores in several domains (affecting only incontinence in the urinary domain), despite a smaller prostate volume (34 cm(3) vs. 47 cm(3); p < 0.01).


CONCLUSIONS
Patients with a large prostate volume have a great risk of irritative/obstructive symptoms (particularly dysuria) in the acute radiotherapy phase. These symptoms recover rapidly and do not influence long-term HRQOL.
Pinkawa
Michael
M
Department of Radiotherapy, RWTH Aachen University, Aachen, Germany. mpinkawa@ukaachen.de
Fischedick
Karin
K
Asadpour
Branka
B
Gagel
Bernd
B
Piroth
Marc D
MD
Nussen
Sandra
S
Eble
Michael J
MJ
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D019540:Area Under Curve; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D011859:Radiography; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D012007:Rectum / Q000000981:diagnostic imaging / Q000528:radiation effects; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000528:radiation effects; D014555:Urination Disorders / Q000209:etiology*
D000726:Androgen Antagonists