title: Longitudinal assessment of quality of life after surgery, conformal brachytherapy, and intensity-modulated radiation therapy for prostate cancer.
abstract: OBJECTIVE
  We evaluated quality-of-life changes (QoL) in 907 patients treated with either radical prostatectomy (open or laparoscopic), real-time planned conformal brachytherapy, or high-dose intensity-modulated radiotherapy (IMRT) on a prospective IRB-approved longitudinal study.
  
  
  METHODS
  Validated questionnaires given pretreatment (baseline) and at 3, 6, 9, 12, 15, 18, 24, 36, and 48 months addressed urinary function, urinary bother, bowel function, bowel bother, sexual function, and sexual bother.
  
  
  RESULTS
  At 48 months, surgery had significantly higher urinary incontinence than others (both P<.001), but fewer urinary irritation/obstruction symptoms (all P<.001). Very low levels of bowel dysfunction were observed and only small subsets in each group showed rectal bleeding. Brachytherapy and IMRT showed better sexual function than surgery accounting for baseline function and other factors (delta 14.29 of 100, 95% CI, 8.57-20.01; and delta 10.5, 95% CI, 3.78-17.88). Sexual bother was similar. Four-year outcomes showed persistent urinary incontinence for surgery with more obstructive urinary symptoms for radiotherapy. Using modern radiotherapy delivery, bowel function deterioration is less-often observed. Sexual function was strongly affected in all groups yet significantly less for radiotherapy.
  
  
  CONCLUSIONS
  Treatment selection should include patient preferences and balance predicted disease-free survival over a projected time vs potential impairment of QoL important for the patient.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA. Electronic address: zelefskm@mskcc.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Bing Ying
authors.initials: BY
authors.lastname: Poon
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Pei
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D003672:Defecation / Q000528:radiation effects; D018572:Disease-Free Survival; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000534:rehabilitation; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000534:rehabilitation / Q000601:surgery*; D011788:Quality of Life; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology
keywords: Brachytherapy; Prostate cancer; Quality of life; Radiotherapy; Surgery