SAN ANTONIO — A prospective, randomized study comparing external beam radiotherapy with radical prostatectomy for localized prostate cancer found no clear winner in terms of quality of life during the 2 years after treatment, Savino M. Di Stasi, M.D., said at the annual meeting of the American Urological Association.
For both treatments, overall health-related quality of life declined in the first month and returned to baseline in 6–12 months, said Dr. Di Stasi of Tor Vergata University, in Rome. During the first month, patients receiving radical prostatectomy reported a significantly worse quality of life, compared with patients receiving external beam radiotherapy (EBRT).
The study involved 137 men, 96 of whom were evaluated at 1, 3, 6, 12, and 24 months. The investigators used an Italian language version of the Functional Assessment of Cancer Therapy-General (FACT-G), a validated quality of life instrument.
Significant group differences appeared in three FACT-G subtests, those measuring urinary, bowel, and sexual function.
In terms of urinary function, radical prostatectomy was worse than EBRT for the entire follow-up period, with 11% of men in the radical prostatectomy group and 3% of men in the EBRT remaining incontinent at 2 years.
On the other hand, radical prostatectomy beat EBRT in terms of bowel function. At 2 years, 92% of men in the radical prostatectomy group, compared with 73% of men in the EBRT group, reported bowel function.
Sexual function was significantly better in the EBRT group than in the radical prostatectomy group just after treatment. However, the EBRT group showed a modest but statistically significant decline in sexual function over 2 years, whereas the radical prostatectomy group improved over time.
At the end of the follow-up period, sexual dysfunction remained more common in the radical prostatectomy group than in the EBRT group (70% vs. 61%).
In spite of the fact that neither treatment showed a clear advantage in terms of quality of life, Dr. Di Stasi's impression is that most patients would choose EBRT.