title: Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer.
abstract: BACKGROUND
  Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to adjacent normal tissues. Large fraction sizes may increase the risk of functional decrements. Treatment-related bother may be more important to a patient than treatment-related dysfunction. This study reports on patient-reported outcomes following SBRT for clinically localized prostate cancer.
  
  
  METHODS
  Between August 2007 and July 2011, 228 consecutive hormone-naïve patients with clinically localized prostate cancer were treated with 35-36.25 Gy SBRT delivered using the CyberKnife Radiosurgical System (Accuray) in 5 fractions. Quality of life was assessed using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite (EPIC)-26. Urinary symptom flare was defined as an AUA score 15 or more with an increase of 5 or more points above baseline 6 months after treatment.
  
  
  RESULTS
  228 patients (88 low-, 126 intermediate- and 14 high-risk) at a median age of 69 (44-90) years received SBRT with a minimum follow-up of 24 months. EPIC urinary and bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 9 months and 18 months before returning to near baseline 2 years post-SBRT. 14.5% of patients experienced late urinary symptom flare following treatment. Patients who experienced urinary symptom flare had poorer bowel quality of life following SBRT. EPIC scores for urinary bother declined transiently, first at 1 month and again at 12 months, before approaching pre-treatment scores by 2 years. Bowel bother showed a similar pattern, but the second decline was smaller and lasted 9 months to 18 months. EPIC sexual summary and bother scores progressively declined over the 2 years following SBRT without recovery.
  
  
  CONCLUSIONS
  In the first 2 years, the impact of SBRT on urination and defecation was minimal. Transient late increases in urinary and bowel dysfunction and bother were observed. However, urinary and bowel function and bother recovered to near baseline by 2 years post-SBRT. Sexual dysfunction and bother steadily increased following treatment without recovery. SBRT for clinically localized prostate cancer was well tolerated with treatment-related dysfunction and bother comparable to conventionally fractionated radiation therapy or brachytherapy.
authors: Onita
authors: O
authors: Bhattasali
authors: Leonard N
authors: LN
authors: Chen
authors: Jennifer
authors: J
authors: Woo
authors: Jee-Won
authors: JW
authors: Park
authors: Joy S
authors: JS
authors: Kim
authors: Rudy
authors: R
authors: Moures
authors: Thomas
authors: T
authors: Yung
authors: Siyuan
authors: S
authors: Lei
authors: Brian T
authors: BT
authors: Collins
authors: Keith
authors: K
authors: Kowalczyk
authors: Simeng
authors: S
authors: Suy
authors: Anatoly
authors: A
authors: Dritschilo
authors: John H
authors: JH
authors: Lynch
authors: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N,W,, Washington, D,C 20007, USA. spc9@gunet.georgetown.edu.
authors: Sean P
authors: SP
authors: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology; D016634:Radiosurgery / Q000009:adverse effects; D057566:Self Report; D012725:Sexual Behavior / Q000528:radiation effects; D016896:Treatment Outcome; D014554:Urination / Q000528:radiation effects