title: Patient-reported quality of life during definitive and postprostatectomy image-guided radiation therapy for prostate cancer.
abstract: OBJECTIVE
  The importance of patient-reported outcomes is well-recognized. Long-term patient-reported symptoms have been described for individuals who completed radiation therapy (RT) for prostate cancer. However, the trajectory of symptom development during the course of treatment has not been well-described in patients receiving modern, image-guided RT.
  
  
  METHODS
  Quality-of-life data were prospectively collected for 111 prostate cancer patients undergoing RT using the validated Prostate Cancer Symptom Indices, which assessed 5 urinary obstructive/irritative and 6 bowel symptoms. Patients who received definitive RT (N = 73) and postprostatectomy RT (N = 38) were analyzed separately. The frequency and severity of symptoms over multiple time points are reported.
  
  
  RESULTS
  An increasing number of patients had clinically meaningful urinary and bowel symptoms over the course of RT. A greater proportion of patients undergoing definitive RT reported clinically meaningful urinary symptoms at the end of RT compared with baseline in terms of flow (33% vs 19%) and frequency (39% vs 18%). Individuals receiving postprostatectomy radiation also reported an increase in symptoms including frequency (29% vs 3%) and nocturia (50% vs 21%). Clinically meaningful bowel symptoms were less commonly reported. Patients receiving definitive RT reported an increase in diarrhea (9% vs 4%) and urgency (12% vs 6%) at the completion of RT compared with baseline. Both bowel and urinary symptoms approached their baseline levels by the time of first follow-up after treatment completion. The majority of patients who had clinically meaningful urinary or bowel symptoms during RT did not have them at 2 years or beyond, and development of new symptoms in the long term was uncommon.
  
  
  CONCLUSIONS
  There is a modest increase in urinary and bowel symptoms over the course of treatment for individuals receiving definitive and postprostatectomy image-guided RT. These data can help inform both providers and patients regarding the trajectory of symptoms and allow for reasonable expectations regarding toxicity under treatment.
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina; Harvard Medical School, Boston, Massachusetts.
authors.forename: Kevin
authors.initials: K
authors.lastname: Diao
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Lobos
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina; Department of Radiation Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors.forename: Eda
authors.initials: E
authors.lastname: Yirmibesoglu
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Ram
authors.initials: R
authors.lastname: Basak
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Hendrix
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Brittney
authors.initials: B
authors.lastname: Barbosa
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Miller
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Pearlstein
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Goldin
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Andrew Z
authors.initials: AZ
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Electronic address: Ronald_chen@med.unc.edu.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
mesh_terms: D000368:Aged; D003672:Defecation / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011788:Quality of Life; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014554:Urination / Q000528:radiation effects