title: Comparison of health-related quality of life 5 years after SPIRIT: Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial.
abstract: OBJECTIVE
  The American College of Surgeons Oncology Group phase III Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial comparing radical prostatectomy (RP) and brachytherapy (BT) closed after 2 years due to poor accrual. We report health-related quality of life (HRQOL) at a mean of 5.3 years for 168 trial-eligible men who either chose or were randomly assigned to RP or BT following a multidisciplinary educational session.
  
  
  METHODS
  After initial lack of accrual, a multidisciplinary educational session was introduced for eligible patients. In all, 263 men attended 47 sessions. Of those, 34 consented to random assignment, 62 chose RP, and 94 chose BT. Five years later, these 190 men underwent HRQOL evaluation by using the cancer-specific 50-item Expanded Prostate Cancer Index Composite, the Short Form 12 Physical Component Score, and Short Form 12 Mental Component Score. Response rate was 88.4%. The Wilcoxon rank sum test was used to compare summary scores between the two interventions.
  
  
  RESULTS
  Of 168 survey responders, 60.7% had BT (9.5% randomly assigned) and 39.3% had RP (9.5% randomly assigned). Median age was 61.4 years for BT and 59.4 for RP (P = .05). Median follow-up was 5.2 years (range, 3.2 to 6.5 years). For BT versus RP, there was no difference in bowel or hormonal domains, but men treated with BT scored better in urinary (91.8 v 88.1; P = .02) and sexual (52.5 v 39.2; P = .001) domains, and in patient satisfaction (93.6 v 76.9; P < .001).
  
  
  CONCLUSIONS
  Although treatment allocation was random in only 19%, all patients received identical information in a multidisciplinary setting before selecting RP, BT, or random assignment. HRQOL evaluated 3.2 to 6.5 years after treatment showed an advantage for BT in urinary and sexual domains and in patient satisfaction.
authors.affiliation: University of Toronto, University Health Network, and Princess Margaret Hospital, Toronto, Ontario, Canada. jcrook@bccancer.bc.ca
authors.forename: Juanita Mary
authors.initials: JM
authors.lastname: Crook
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gomez-Iturriaga
authors.forename: Kris
authors.initials: K
authors.lastname: Wallace
authors.forename: Clement
authors.initials: C
authors.lastname: Ma
authors.forename: Sharon
authors.initials: S
authors.lastname: Fung
authors.forename: Shabbir
authors.initials: S
authors.lastname: Alibhai
authors.forename: Michael
authors.initials: M
authors.lastname: Jewett
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects; D002170:Canada; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology / Q000523:psychology