title: Quality of Life after post-prostatectomy intensity modulated radiation therapy to the prostate bed with or without the use of gold fiducial markers for image guidance or higher total radiotherapy doses.
abstract: OBJECTIVE
  To evaluate quality of life (QoL) after post-prostatectomy intensity modulated radiation therapy (IMRT) in the "adjuvant" setting starting within 4 months of radical prostatectomy for adverse features; and "salvage" setting for a PSA≥0.2ng/mL.
  
  
  METHODS
  Retrospective review of 130 patients who underwent IMRT to the prostate bed±gold fiducial marker placement for image guidance to 64.8-72.0Gy (median, 70.2Gy) between 2004 and 2013. Higher doses were defined as 70.2-72.0Gy and lower doses were defined as 64.8-68.4Gy. Androgen deprivation therapy (ADT) was given to 4/48 (8%) adjuvant patients and 9/82 (11%) salvage patients. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and Expanded Prostate Cancer Index Composite-26-bowel (EPIC-26-bowel) questionnaires were used to assess urinary, sexual, and bowel QoL, respectively.
  
  
  RESULTS
  Median follow-up was 46 months. There were better urinary (p=0.03) and sexual (p=0.002) QoL scores with adjuvant IMRT relative to salvage IMRT. The use of prostate bed fiducial markers did not significantly affect urinary, sexual, or bowel QoL (p=0.39, p=0.49, and p=0.40, respectively). Higher total radiotherapy doses did not significantly affect urinary, sexual, or bowel QoL (p=0.21, p=0.61, and p=0.36, respectively).
  
  
  CONCLUSIONS
  There was no significant change in urinary, sexual, and bowel sexual QoL with post-prostatectomy IMRT regardless of whether prostate bed fiducial markers or higher total radiotherapy doses were used. QoL with IMRT in the present study compares favorably with prior reports for three-dimensional conformal radiation therapy.
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Yazan A
authors.initials: YA
authors.lastname: Abuodeh
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Arash O
authors.initials: AO
authors.lastname: Naghavi
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Tzu-Hua
authors.initials: TH
authors.lastname: Juan
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Zhenjun
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Cancer Treatment Centers of America, Newnan, Georgia, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Wilder
mesh_terms: D003131:Combined Modality Therapy; D057918:Fiducial Markers; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology*; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Postoperative Care; Prostate; Quality of Life