title: The Effect of Salvage Radiotherapy and its Timing on the Health-related Quality of Life of Prostate Cancer Patients.
abstract: The impact of salvage radiotherapy (SRT) and its timing on health-related quality of life (HRQoL) in prostate cancer patients is still unclear.
  
  
  
  To compare the HRQoL of patients who underwent SRT with that of patients who underwent radical prostatectomy (RP) only and to investigate whether SRT timing is associated with HRQoL.
  
  
  
  All SRT patients (n=241) and all RP-only patients (n=1005) were selected from a prospective database (2004-2015). The database contained HRQoL and prostate problem assessments up to 2 yr after last treatment.
  
  
  
  Mixed effects growth modelling adjusting for significant differences in patient characteristics and baseline HRQoL was used to analyze the association between: (1) "treatment" (RP-only vs SRT) and (2) "timing of SRT" with changes in HRQoL.
  
  
  
  SRT patients showed significantly (p<0.05) poorer recovery from urinary, bowel, and erectile function after their last treatment (clinically meaningful difference for urinary and erectile function). Patients with a longer interval (≥ 7 mo) between RP and SRT reported significantly better sexual satisfaction after SRT (p=0.02), and a better urinary function recovery (p=0.03). Limitations of the study include the nonrandom design and the variability in timing of HRQoL measurements.
  
  
  
  Up to 2 yr after treatment, SRT patients reported poorer HRQoL in several HRQoL domains compared with RP-only patients, but not in overall HRQoL. Delaying the start of SRT after RP may limit the incidence and duration of urinary and sexual problems. Nevertheless, decisions regarding SRT timing should also be based on the potential benefits in disease recurrence.
  
  
  
  Patients who receive radiotherapy after surgery may experience poorer urinary, bowel, and erectile function compared with patients who undergo surgery only. Although more research is needed, delaying radiotherapy seems to limit its impact on urinary and sexual functioning.
authors.affiliation: University Medical Centre Utrecht, Utrecht, The Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: van Stam
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Floris J
authors.initials: FJ
authors.lastname: Pos
authors.affiliation: University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: J L H Ruud
authors.initials: JL
authors.lastname: Bosch
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Jacobien M
authors.initials: JM
authors.lastname: Kieffer
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Corinne N
authors.initials: CN
authors.lastname: Tillier
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: h.vd.poel@nki.nl.
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D000071066:Patient Reported Outcome Measures; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000523:psychology / Q000532:radiotherapy / Q000601:surgery; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D020127:Recovery of Function; D018570:Risk Assessment; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D061665:Time-to-Treatment
keywords: Health-related quality of life; Prostate cancer; Salvage radiotherapy; Timing radiotherapy