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Hashimoto Y, Motegi A, Akimoto T, Mitsuhashi N, Ohmatsu K, Kawanishi M, Kono S, Kuribayashi S, Iizuka J, Karasawa K. Relationship between changes in quality of life and genitourinary toxicity grade after brachytherapy with I-125 alone for localised prostate cancer. Rep Pract Oncol Radiother 2023; 28:24-35. [PMID: 37122903 PMCID: PMC10132191 DOI: 10.5603/rpor.a2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background The relationship between the grading of toxicities based on toxicity criteria and longitudinal changes in quality of life (QOL) scores after permanent prostate brachytherapy (PPB) for localized prostate cancer remains unclear. This study aimed to evaluate these relationships. Materials and methods We assessed 107 patients treated with PPB using Iodine-125 alone from May 2007 to April 2010. Disease-specific QOL scores before PPB and at 1, 3, 6, 12, and 24 months after PPB were retrospectively evaluated with the Expanded Prostate Cancer Index Composite (EPIC), focusing on urinary domains. Toxicities were graded using the Radiation therapy oncology group and the European organization for research and treatment of cancer toxicity criteria. Results The median follow-up duration was 116 (range 18-148) months. Thirty-four patients (31.8%) developed grade ≥ 2 acute genitourinary (GU) toxicities; six (5.6%) developed grade ≥ 2 late GU toxicities. The general urinary domain score dropped significantly at 1 month (77.1 ± 14.1) post-PPB compared to the baseline score (92.2 ± 8.2), and then gradually returned to the baseline level by 12 months (93.7 ± 8.3) post-PPB. Reductions in the general urinary domain scores, including its subscale scores at 1, 3, and 6-months post-PPB were significantly greater among patients with grade ≥ 2 GU toxicity than among those with grade 0-1 GU toxicity. Changes in urinary domain scores demonstrated a close relationship with acute GU toxicity grades after PPB. Conclusions Longitudinal assessments of the EPIC QOL scores provided additional information regarding time-course changes in GU toxicities after PPB.
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Affiliation(s)
- Yaichiro Hashimoto
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | - Atsushi Motegi
- Radiation Oncology and Particle Therapy, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Tetsuo Akimoto
- Radiation Oncology and Particle Therapy, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Norio Mitsuhashi
- Radiation Therapy Center, Hitachinaka General Hospital, Hitachinaka, Japan
| | - Kenta Ohmatsu
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | - Miki Kawanishi
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | - Sawa Kono
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | | | - Junpei Iizuka
- Urology, Tokyo Joshi Ika Daigaku Byoin, Shinjuku-ku, Japan
| | - Kumiko Karasawa
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
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Walsh EA, Antoni MH, Popok PJ, Moreno PI, Penedo FJ. Effects of a randomized-controlled trial of cognitive behavioral stress management: Psychosocial adaptation and immune status in men with early-stage prostate cancer. Gen Hosp Psychiatry 2022; 79:128-134. [PMID: 36375341 PMCID: PMC9729459 DOI: 10.1016/j.genhosppsych.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Targets of intervention in cognitive behavioral stress management (CBSM), such as benefit finding (BF) and perceived stress management skills (PSMS), may counteract stress-related changes that impact the immune system. This study tested whether BF, PSMS, and optimism influence the effects of CBSM on immune status in men with prostate cancer. METHODS Men with prostate cancer were randomized to receive CBSM or a psychoeducation (PE) control comparison (NCT05486754). Life Orientation Test-Revised assessed baseline optimism. The Benefit Finding Scale and Measure of Current Status measured BF and PSMS after CBSM. T-cells and T-helper cells captured immune status change at baseline and 6-months post-CBSM. MPlus and SPSS (PROCESS) tested condition effects and moderated mediation, controlling for covariates. RESULTS 256 primarily middle-aged, White Non-Hispanic or Hispanic men enrolled. PSMS mediated CBSM effects on T-cell and T-helper cell percentage, such that T-cell and T-helper cell percentages were reduced in men in CBSM versus PE via PSMS. Optimism moderated this mediation with the mediating effect of PSMS only observed among men with average optimism versus those with low or high optimism. CONCLUSION Baseline psychological characteristics, as well as limited specificity of immune measurement, could explain the conditional effects in this sample. TRIAL REGISTRATION NCT05486754.
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Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America.
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America; Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States of America
| | - Paula J Popok
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States of America; Department of Public Health Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States of America
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America; Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States of America
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Hjälm-Eriksson M, Ullén A, Nilsson S, Johansson H, Nilsson J, Castellanos E, Brandberg Y. High levels of health-related quality of life five years after curative treatment of prostate cancer with HDR-brachytherapy and external beam radiation. Acta Oncol 2022; 61:1179-1185. [PMID: 36062835 DOI: 10.1080/0284186x.2022.2115314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this cross-sectional study was to investigate long-term health-related quality of life (HRQoL) in men with prostate cancer treated 2002-2008 with external beam radiotherapy (EBRT) combined with high dose-rate brachytherapy (HDRBT), Cohort A, and to compare these data with age-adjusted normative data. In addition, differences in HRQoL following adjustments of the brachytherapy technique in 2001 were investigated by comparing Cohort A with men treated at the same clinic from 1998-2000, Cohort B. METHODS AND MATERIAL Cohort A: 1495 men treated with EBRT 2 Gy to 50 Gy and 2 fractions of 10 Gy HDRBT at a single centre, 2002-2008, still alive at five years. As part of routine follow-up, the patients responded to the EORTC QLQ-C30 and PR-25 questionnaires. Cohort B: HRQoL data was retrieved from an earlier study from the original article. RESULTS In Cohort A, 1046 (70%) men completed the questionnaires at five years, median age 66 years. In general, HRQoL mean scores were high and similar to Swedish age-matched normative data. Concerning disease-specific HRQoL, low levels of bowel and urinary problems were reported, in contrast to a substantial effect on sexual functioning. 'No' or 'A little' problems with faecal incontinence and urinary incontinence were reported by 98% and 93% of patients, respectively. The corresponding figure for sexual functioning was 39%. A difference in the frequency of nocturia in favour of Cohort A was the only statistically significant difference between Cohort A and B found in general and disease-specific HRQOL (p = 0.03), despite modifications in the brachytherapy procedure introduced in 2001. CONCLUSION Long-term general HRQoL was rated high and comparable to an aged-matched reference population five years after treatment with combined radiotherapy. Disease-specific HRQoL was still affected, foremost in the sexual domain.
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Affiliation(s)
- Marie Hjälm-Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic cancer, Genitourinary oncology and urology unit, Karolinska University Hospital, Stockholm, Sweden
| | - Sten Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Josef Nilsson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Enrique Castellanos
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic cancer, Genitourinary oncology and urology unit, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic cancer, Genitourinary oncology and urology unit, Karolinska University Hospital, Stockholm, Sweden
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Robbins R, Hanna R, Ejikeme C, Orstad SL, Porten S, Salter CA, Sanchez-Nolasco T, Vieira D, Loeb S. Systematic review of sleep and sleep disorders among prostate cancer patients and caregivers: A call to action for using validated sleep assessments during prostate cancer care. Sleep Med 2022; 94:38-53. [DOI: 10.1016/j.sleep.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022]
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Zamora V, Garin O, Pardo Y, Pont À, Gutiérrez C, Cabrera P, Gómez-Veiga F, Pijoan JI, Litwin MS, Ferrer M. Mapping the Patient-Oriented Prostate Utility Scale From the Expanded Prostate Cancer Index Composite and the Short-Form Health Surveys. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1676-1685. [PMID: 34711369 DOI: 10.1016/j.jval.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to develop mapping algorithms from the Expanded Prostate Cancer Index Composite (EPIC) and the Short-Form (SF) Health Surveys to the Patient-Oriented Prostate Utility Scale (PORPUS), an econometric instrument specifically developed for patients with prostate cancer. METHODS Data were drawn from 2 cohorts concurrently administering PORPUS, EPIC-50, and SF-36v2. The development cohort included patients who had received a diagnosis of localized or locally advanced prostate cancer from 2017 to 2019. The validation cohort included men who had received a diagnosis of localized prostate cancer from 2014 to 2016. Linear regression models were constructed with ln(1 - PORPUS utility) as the dependent variable and scores from the original and brief versions of the EPIC and SF as independent variables. The predictive capacity of mapping models constructed with all possible combinations of these 2 instruments was assessed through the proportion of variance explained (R2) and the agreement between predicted and observed values. Validation was based on the comparison between estimated and observed utility values in the validation cohort. RESULTS Models constructed with EPIC-50 with and without SF yielded the highest predictive capacity (R2 = 0.884, 0.871, and 0.842) in comparison with models constructed with EPIC-26 (R2 = 0.844, 0.827, and 0.776). The intraclass correlation coefficient was excellent in the 4 models (>0.9) with EPIC and SF. In the validation cohort, predicted PORPUS utilities were slightly higher than those observed, but differences were not statistically significant. CONCLUSIONS Mapping algorithms from both the original and the abbreviated versions of the EPIC and the SF Health Surveys allow estimating PORPUS utilities for economic evaluations with cost-utility analyses in patients with prostate cancer.
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Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Yolanda Pardo
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | - Patricia Cabrera
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Gómez-Veiga
- Complejo Hospitalario Universitario de Salamanca, Grupo de Investigación Translacional de Urología, Instituto de Investigación de Salamanca, Salamanca, Spain
| | - José Ignacio Pijoan
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Department of Clinical Epidemiology, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Mark S Litwin
- Schools of Medicine, Public Health and Nursing, University of California, Los Angeles, CA, USA
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
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Thompson E, Barrett W. Ultra-long-term toxicity of prostate brachytherapy. Brachytherapy 2021; 20:595-600. [PMID: 33750644 DOI: 10.1016/j.brachy.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/16/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The true long-term toxicity associated with most radiation treatments is unknown. Prostate cancer patients survive decades after prostate cancer brachytherapy, with unclear long-term toxicity profiles. We therefore evaluated prostate cancer patients who had received I-125 brachytherapy treatment (14,400 cGy) 14-24 years prior and assessed their long-term quality of life based on urinary, bowel, and sexual function. METHODS AND MATERIALS We performed a single-institutional, retrospective analysis of 39 men who received brachytherapy between 1996 and 2005. Analysis was based on physician evaluations, laboratory values, and International Prostate Symptom Score (IPSS) results. RESULTS At last followup, the mean patient age was 80 years (median 81 years), with a mean of 17.8 years posttreatment followup. Fifteen percent of patients had experienced recurrence. Urinary symptoms were limited, with 0% of patients reporting dysuria, 13% reporting incontinence, and 33% on medication for urinary symptoms. Average times nocturia was 1.7 with mean IPSS of 6.4. With regard to bowel symptoms, 3% of patients reported incontinence, 8% noted diarrhea, 3% had rectal bleeding, 8% noted constipation, and no patients required prescription medication for bowel function. Thirty-nine percent of patients potent before treatment reported being potent with or without medication. CONCLUSIONS Prostate cancer survivors, postbrachytherapy treatment, have an overall good quality of life for many years to come. Urinary and bowel symptoms are limited, IPSS scores are generally low, and patients who consider sexual function important at their stage in life are frequently found to be potent. Overall, the long-term side effects of brachytherapy are limited at 14-24 years posttreatment.
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Affiliation(s)
- Elizabeth Thompson
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - William Barrett
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH.
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Ten-year longitudinal health-related quality of life following iodine-125 brachytherapy monotherapy for localized prostate cancer. J Contemp Brachytherapy 2021; 12:540-546. [PMID: 33437301 PMCID: PMC7787209 DOI: 10.5114/jcb.2020.101686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose This prospective longitudinal study quantifies health-related quality of life (HRQoL) up to 10 years following permanent iodine-125 (125I) prostate brachytherapy alone for localized prostate cancer. Material and methods In total, 120 patients completed a validated expanded prostate cancer index composite (EPIC) questionnaire pre-treatment and at 8 time points after treatment (6 weeks, 6, 10, 18 months, and 2, 3, 5, 10 years). At each time point, clinically relevant small, moderate, and severe declines in HRQoL were defined as 0.2-0.5 SD, 0.5-0.8 SD, and > 0.8 SD of baseline function for each of urinary, bowel, and sexual domains, respectively. Results Response rates in the first two years were > 90%, but thereafter dropped to 75% and 48% at 5 and 10 years, respectively. 50 patients (41.6%) responded at all stages. Maximal deterioration in mean urinary and sexual summary scores was noted 6 weeks after implant, with severe urinary symptoms and moderate bowel/sexual symptoms. At 6 months, urinary and bowel quality of life (QoL) had improved to mild impairment, which then fully resolved at 10 months. Sexual QoL remained mildly impaired throughout the 10 years of follow-up. At 10 years, new mild impairment of urinary and bowel QoL was found. Conclusions Clinically mild changes in urinary, bowel, and sexual QoL are found 10 years after 125I monotherapy. The impairment in sexual function persists from treatment, but urinary and bowel symptoms are new at 10 years.
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Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in "chronic" cancer survivors: a meta-analysis. J Cancer Surviv 2020; 14:504-517. [PMID: 32162194 DOI: 10.1007/s11764-020-00869-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Cancer survivors are now living longer giving rise to a new concept-chronic cancer as survivors continue to face long-term consequences of cancer and its treatment. For these survivors, QOL becomes a vital consideration in understanding their survivorship and the long-term impact of cancer and its treatment. The primary aim of this review is to describe QOL in cancer survivors two or more years from diagnosis. METHODS A meta-analysis was completed of relevant studies assessing QOL in long-term cancer survivorship using PubMed, CINHAL, and PsycINFO. A total of 64 articles met inclusion criteria and included in the analysis. Standardized effect sizes and errors were calculated using previously published standard QOL pass rates to compare QOL across measurement tools and calculate cumulative effect sizes (CES). Fixed-effect or random-effects models were used based on the presence of significant heterogeneity of ≤ 0.10. RESULTS Physical health (CES = - 0.894; CI, - 1.472, - 0.316), role-physical health (CES = - 2.039; CI, - 2.643, - 1.435), and mental health (CES = - 0.870; CI, - 1.447, - 0.292) had large, negative cumulative effect sizes signifying worse QOL compared with acceptable QOL rates. Tested moderators, cancer type, average age, country of origin, time since diagnosis, or decade of diagnosis, were not significant to explain heterogeneity between included studies. CONCLUSION QOL is significantly impacted 2 to 26 years after cancer diagnosis. More research is needed to determine possible moderators of QOL in long-term cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS QOL continues to be significantly impacted in long-term cancer survivorship. More research is needed to understand the impact of these findings on care needs for survivors with chronic cancer.
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Affiliation(s)
- Jenny Firkins
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | - Lissi Hansen
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Martha Driessnack
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.,Division of Clinical Psychology, Oregon Health & Science University, 3314 SW US Veterans Hospital Road, Portland, OR, 97239, USA
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Koga H, Naito S, Ishiyama H, Yorozu A, Saito S, Kojima S, Higashide S, Kikuchi T, Nakamura K, Dokiya T, Fukushima M. Patient-reported health-related quality of life up to three years after the treatment with permanent brachytherapy: Outcome of the large-scale, prospective longitudinal study in Japanese–Prostate Cancer Outcome Study by Permanent I-125 Seed Implantation (J-POPS). Brachytherapy 2019; 18:806-813. [DOI: 10.1016/j.brachy.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, Ferrer F, Boladeras A, Zamora V, Fosså S, Storås AH, Sanda M, Serra-Sutton V, Ferrer M. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:23-44. [PMID: 29673922 DOI: 10.1016/j.ctrv.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments. METHODS We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747. RESULTS Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I2 = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening. CONCLUSIONS No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
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Affiliation(s)
- Mónica Ávila
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Silvia López
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona University UB, Barcelona, Spain
| | - Sophie Fosså
- Oslo University Hospital, University of Oslo, Norway
| | - Anne H Storås
- Oslo University Hospital, University of Oslo, Norway
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, United States
| | - Vicky Serra-Sutton
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Blanchard P, Pugh TJ, Swanson DA, Mahmood U, Chen HC, Wang X, Graber WJ, Kudchadker RJ, Bruno T, Feeley T, Frank SJ. Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study. Brachytherapy 2017; 17:265-276. [PMID: 29269207 DOI: 10.1016/j.brachy.2017.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. METHODS AND MATERIALS Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. RESULTS From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. CONCLUSIONS The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Houston, TX
| | - David A Swanson
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Usama Mahmood
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William J Graber
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa Bruno
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Atkinson TM, Stover AM, Storfer DF, Saracino RM, D'Agostino TA, Pergolizzi D, Matsoukas K, Li Y, Basch E. Patient-Reported Physical Function Measures in Cancer Clinical Trials. Epidemiol Rev 2017; 39:59-70. [PMID: 28453627 PMCID: PMC5858035 DOI: 10.1093/epirev/mxx008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/22/2022] Open
Abstract
Patient-reported outcomes (PROs) are increasingly used to monitor treatment-related symptoms and physical function decrements in cancer clinical trials. As more patients enter survivorship, it is important to capture PRO physical function throughout trials to help restore pretreatment levels of function. We completed a systematic review of PRO physical function measures used in cancer clinical trials and evaluated their psychometric properties on the basis of guidelines from the US Food and Drug Administration. Five databases were searched through October 2015: PubMed/MEDLINE, EMBASE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Health and Psychosocial Instruments, and Cochrane. From an initial total of 10,233 articles, we identified 108 trials that captured PRO physical function. Within these trials, approximately 67% used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and 25% used the Medical Outcomes Study Short Form 36. Both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Medical Outcomes Study Short Form 36 instruments generically satisfy most Food and Drug Administration requirements, although neither sought direct patient input as part of item development. The newer Patient-Reported Outcomes Measurement Information System physical function short form may be a brief, viable alternative. Clinicians should carefully consider the psychometric properties of these measures when incorporating PRO instrumentation into clinical trial design to provide a more comprehensive understanding of patient function.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Angela M Stover
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel F Storfer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas A D'Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Denise Pergolizzi
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantina Matsoukas
- Information Systems, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Chao MW, Grimm P, Yaxley J, Jagavkar R, Ng M, Lawrentschuk N. Brachytherapy: state-of-the-art radiotherapy in prostate cancer. BJU Int 2015; 116 Suppl 3:80-8. [DOI: 10.1111/bju.13252] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Peter Grimm
- Prostate Cancer Center of Seattle; Seattle WA USA
| | | | - Raj Jagavkar
- St Vincent's Hospital; Darlinghurst NSW Australia
| | - Michael Ng
- Radiation Oncology Victoria; Epping Vic. Australia
| | - Nathan Lawrentschuk
- Department of Surgery and Olivia Newton John Cancer Research Institute; Austin Hospital; Heidelberg Vic. Australia
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
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Aluwini S, Busser WMH, Alemayehu WG, Boormans JL, Kirkels WJ, Jansen PP, Praag JO, Bangma CH, Kolkman-Deurloo IKK. Toxicity and quality of life after high-dose-rate brachytherapy as monotherapy for low- and intermediate-risk prostate cancer. Radiother Oncol 2015; 117:252-7. [PMID: 26409832 DOI: 10.1016/j.radonc.2015.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/20/2015] [Accepted: 09/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The use of HDR brachytherapy (HDR-BT) as monotherapy for prostate cancer (PC) is increasing worldwide with good tumour control rates and acceptable toxicity. We report our results on toxicity and quality of life (QoL) after HDR-BT monotherapy for PC patients. MATERIALS AND METHODS 166 low- and intermediate-risk localized PC patients were treated with HDR-BT to a total dose of 38Gy in four fractions. Genitourinary (GU) and gastrointestinal (GI) toxicities were prospectively assessed using EORTC-RTOG questionnaires and physicians charts. QoL was evaluated using EORTC QLQ-PR25 questionnaires. RESULTS Three months after treatment, acute GU and GI toxicities were reported in 10.8% and 7.2%. Acute toxicity resolved within two months in the majority of patients (61%). Late grade ⩾ 2 GU and GI toxicity were reported in 19.7% and 3.3% of patients 12 months after HDR-BT. Mean QLQ-PR25 scores showed clinically relevant changes from baseline for urinary symptoms and sexual functioning. With a mean follow-up of 35 months, biochemical failure was observed in 2.4%. Overall survival at 60 months was 93.6% and cancer-specific survival was 100%. CONCLUSIONS HDR-BT monotherapy for localized PC showed excellent clinical outcome and acceptable acute and late toxicity. Urinary symptoms and sexual function QoL decreased after treatment.
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Affiliation(s)
- Shafak Aluwini
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Wendy M H Busser
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wim J Kirkels
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Peter P Jansen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - John O Praag
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Oton CA, Blanco L, Oton LF, Moral S. Comparing CTVs for permanent prostate brachytherapy. Clin Transl Oncol 2014; 17:393-7. [PMID: 25351173 DOI: 10.1007/s12094-014-1245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To delineate the clinical target volume (CTV) in low dose rate (LDR) brachytherapy for prostate cancer, American Brachytherapy Society (ABS) recommends a CTV = prostate. ESTRO advocates a CTV = prostate + 3 mm excluding rectum and many authors use and recommend other different CTVs. This study aims to: (1) evaluate the appropriateness of these recommendations and (2) test the applicability of seed distributions on the different CTVs and contrast the dosimetric differences. MATERIALS AND METHODS Ninety-eight patients treated with (125)I seeds (dose 145 Gy; CTV = prostate) were studied. We established for every patient: (1) risk of extraprostatic extension (EPE), (2) adequacy of original plan to an extended CTV with 3 mm-margin (3) a new planning and seed distribution for this CTV and (4) comparison of dosimetry of both plans. RESULTS Mean risk of EPE was 28.46 %. Original plan, when applied to the extended CTV, resulted in unsatisfactory dosimetry. A plan was generated for the 98 extended CTVs meeting all dosimetric specifications. CONCLUSIONS The risk of EPE is high enough to consider a 3 mm-margin around prostate necessary for all cases. A CTV = prostate + 3 mm except rectum as ESTRO recommends is feasible and would adjust planning to the most probable extension of the tumor.
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Affiliation(s)
- C A Oton
- Department of Radiation Oncology, University of La Laguna Tenerife, Santa Cruz de Tenerife, Spain,
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16
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Late urinary side effects 10 years after low-dose-rate prostate brachytherapy: population-based results from a multiphysician practice treating with a standardized protocol and uniform dosimetric goals. Int J Radiat Oncol Biol Phys 2014; 90:570-8. [PMID: 25151536 DOI: 10.1016/j.ijrobp.2014.06.037] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/10/2014] [Accepted: 06/14/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine late urinary toxicity (>12 months) in a large cohort of uniformly treated low-dose-rate prostate brachytherapy patients. METHODS AND MATERIALS From 1998 to 2009, 2709 patients with National Comprehensive Cancer Network-defined low-risk and low-tier intermediate-risk prostate cancer were treated with Iodine 125 ((125)I) low-dose-rate prostate brachytherapy; 2011 patients with a minimum of 25 months of follow-up were included in the study. Baseline patients, treatment, implant factors, and late urinary toxicity (Radiation Therapy Oncology Group [RTOG] grading system and International Prostate Symptom Score [IPSS]) were recorded prospectively. Time to IPSS resolution, late RTOG genitourinary toxicity was examined with Kaplan-Meier and log-rank tests. Cox proportional hazards regression was done for individual covariates and multivariable models. RESULTS Median follow-up was 54.5 months (range, 2-13 years). Actuarial toxicity rates reached 27% and 10% (RTOG ≥2 and ≥3, respectively) at 9-13 years. Symptoms resolved quickly in the majority of patients (88% in 6-12 months). The prevalence of RTOG 0, 1, 2, 3, and 4 toxicity with a minimum of 7 years' follow-up was 70%, 21%, 6.4%, 2.3%, and 0.08%, respectively. Patients with a larger prostate volume, higher baseline IPSS, higher D90, acute toxicity, and age >70 years had more late RTOG ≥2 toxicity (all P≤.02). The IPSS resolved slower in patients with lower baseline IPSS and larger ultrasound prostate volume, those not receiving androgen deprivation therapy, and those with higher D90. The crude rate of RTOG 3 toxicity was 6%. Overall the rate of transurethral resection of the prostate was 1.9%; strictures, 2%; incontinence, 1.3%; severe symptoms, 1.8%; late catheterization, 1.3%; and hematuria, 0.8%. The majority (80%) resolved their symptoms in 6-12 months. CONCLUSION Long-term urinary toxicity after brachytherapy is low. Although actuarial rates increase with longer follow-up (27% RTOG 2 and 10% RTOG 3 at 13 years), symptoms resolve relatively quickly; between 5 and 13 years' follow-up, >90% of patients have minimal urinary toxicity. Refining patient selection criteria, planning, and treatment delivery may further reduce toxicity.
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Acar C, Schoffelmeer CC, Tillier C, de Blok W, van Muilekom E, van der Poel HG. Quality of life in patients with low-risk prostate cancer. A comparative retrospective study: brachytherapy versus robot-assisted laparoscopic prostatectomy versus active surveillance. J Endourol 2013; 28:117-24. [PMID: 23978277 DOI: 10.1089/end.2013.0349] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the quality of life (QoL) after different treatment modalities for low-risk prostate cancer, including brachytherapy, robot-assisted laparoscopic prostatectomy (RALP), and active surveillance (AS) with validated questionnaires. MATERIALS AND METHODS From a prospective database, we selected a total of 144 men with low-grade localized prostate cancer including 65 (45.1%) patients with RALP, 29 (20.2%) with brachytherapy, and 50 (34.7%) whose cancer was managed with AS. QoL was routinely evaluated with validated questionnaires: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30), EORTC-QLQ-Prostate Module (PR)25, International Index of Erectile Function (IIEF)-15, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with a minimum follow-up of 1 year. RESULTS In comparison with baseline scores, the brachytherapy group showed a significant decrease of QoL domain scores of voiding complaints (P=0.010), use of incontinence aids (P=0.011), sexual functioning domain (P=0.011), and erectile function (P≤0.001). In the RALP group, sexual function (P≤0.001), incontinence (P≤0.001), and erectile function were significantly affected. A decrease in sexual function was observed in 71% of men after RALP and 59% after brachytherapy. In 30% of men under AS, a decrease of erectile function score during follow-up was reported. Overall, no significant decrease in general QoL was observed neither for men under AS nor for men treated by brachytherapy or RALP. Clinical factors such as age, prostate size, prostate-specific antigen level, and nerve preservation during RALP were nonpredictive of overall QoL after treatment for the individual patient (P=0.676). CONCLUSION Patients with low-risk prostate cancer who are treated with brachytherapy or RALP report deterioration of QoL of specific domains such as voiding, continence, and sexual functioning in comparison with AS patients. A decrease of erectile function was also observed during AS. Overall QoL was similar for all three treatments options.
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Affiliation(s)
- Cenk Acar
- 1 Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands
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Cosset JM, Hannoun-Lévi JM, Peiffert D, Delannes M, Pommier P, Pierrat N, Nickers P, Thomas L, Chauveinc L. Curiethérapie du cancer prostatique par implants permanents : le point en 2013. Cancer Radiother 2013; 17:111-7. [DOI: 10.1016/j.canrad.2013.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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The Effect of High Dose Rate Brachytherapy in Combination with External Beam Radiotherapy on Men's Health-related Quality of Life and Sexual Function over a 2 Year Time Span. Clin Oncol (R Coll Radiol) 2013. [DOI: 10.1016/j.clon.2012.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Buckstein M, Carpenter TJ, Stone NN, Stock RG. Long-term Outcomes and Toxicity in Patients Treated With Brachytherapy for Prostate Adenocarcinoma Younger Than 60 Years of Age at Treatment With Minimum 10 Years of Follow-up. Urology 2013; 81:364-8. [DOI: 10.1016/j.urology.2012.08.112] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/08/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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Vanagas G, Mickeviciene A, Ulys A. Does quality of life of prostate cancer patients differ by stage and treatment? Scand J Public Health 2012; 41:58-64. [PMID: 23221377 DOI: 10.1177/1403494812467503] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The lack of consensus amongst experts delineate how important it is for patients diagnosed with prostate cancer (PCa) to make an informed decision on available treatment options through an objective discussion of the risks and benefits. One of important benefits could be seen as patient's quality of life (QoL) after treatment. We aimed to assess QoL differences in prostate cancer patients by stage and treatment for a population-based sample. METHODS The cross-sectional PCa patient population-based national level study for a prostate cancer patient population was performed. QoL was investigated with EORTC QLQ-C30. The analysis includes descriptive statistics and evaluation of differences in functional and symptom scales by stage and treatment group by predictors in the model. RESULTS Response rate was 79.1% (N=514). The highest QoL scores were observed in localised PCa, active surveillance treatment group. The lowest scores were observed in advanced stages, chemotherapy treatment group. Between cancer stages, statistically significant differences were observed only in scales of emotional functioning (p<0.001) and social functioning (p<0.001). Between treatment groups, statistically significant differences were observed in scales of physical functioning (p<0.001), role functioning (p<0.001), emotional functioning (p<0.001), and social functioning (p<0.001). CONCLUSIONS Our study highlighted statistically significant differences in QoL between cancer stages and treatment. Understanding how the QoL changes in relation with the selected treatment option can be important to the urologist and individual patient to have realistic expectations as well as to optimise treatment decisions for the prostate cancer patient when exist several alternatives.
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Brachytherapy for prostate cancer does not influence long-term depression rate. Brachytherapy 2012; 11:495-501. [PMID: 22459065 DOI: 10.1016/j.brachy.2012.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/19/2012] [Accepted: 02/15/2012] [Indexed: 11/22/2022]
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In Regard to “Dose Escalation in the Radiation Therapy of Prostate Cancer” (Int J Radiat Oncol Biol Phys 2011;80:1289–1291). Int J Radiat Oncol Biol Phys 2012; 82:1317-8. [DOI: 10.1016/j.ijrobp.2011.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/02/2011] [Indexed: 11/19/2022]
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Roeloffzen EM, van Vulpen M, Battermann JJ, van Roermund JG, Saibishkumar EP, Monninkhof EM. Pretreatment Nomogram to Predict the Risk of Acute Urinary Retention After I-125 Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2011; 81:737-44. [DOI: 10.1016/j.ijrobp.2010.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 11/29/2022]
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A critical analysis of the long-term impact of brachytherapy for prostate cancer: a review of the recent literature. Curr Opin Urol 2011; 21:219-24. [DOI: 10.1097/mou.0b013e3283449d52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hinnen KA, van Vulpen M. Predictors in the outcome of 125I brachytherapy as monotherapy for prostate cancer. Expert Rev Anticancer Ther 2011; 11:115-23. [PMID: 21166516 DOI: 10.1586/era.10.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A number of different prostate cancer treatment modalities exist. Nomograms are used to assist clinicians and patients in choosing the most appropriate treatment. However, the predicted outcome for (125)I brachytherapy is much worse than what would be expected considering the actual survival rates. This underestimation may result in suboptimal treatment decisions. Therefore, better predictors for outcome after (125)I brachytherapy are necessary. The following factors, which may either influence outcome or predict outcome after brachytherapy, are discussed: tumor characteristics and risk stratification, patient age at treatment, obesity, adjuvant androgen-deprivation therapy, prostate-specific antigen bounce, implantation technique and dosimetry. For the prediction of outcome after (125)I brachytherapy, as long as the quality of the implant is optimal, only high-risk prostate cancer was found to have a negative impact on outcome.
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Affiliation(s)
- Karel A Hinnen
- Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA, The Netherlands
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Grant JD, Litwin MS, Kwan L, Lee SP, Steinberg ML, King CR. Does hormone therapy exacerbate the adverse effects of radiotherapy in men with prostate cancer? A quality of life study. J Urol 2011; 185:1674-80. [PMID: 21419449 DOI: 10.1016/j.juro.2010.12.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE We examined whether short course androgen deprivation therapy as an adjunct to radiotherapy would impact health related quality of life outcomes in patients with localized prostate cancer treated definitively with external beam radiation therapy or permanent brachytherapy. MATERIALS AND METHODS From 1999 to 2003 patients were enrolled in a prospective study at our institution and completed validated health related quality of life surveys at defined pretreatment and posttreatment intervals. A total of 81 men received radiotherapy alone and 67 received radiotherapy plus androgen deprivation therapy. Median androgen deprivation therapy duration was 4 months. Univariate and multivariate analysis was done to compare time to return to baseline in 6 distinct health related quality of life domains. RESULTS On univariate analysis the radiotherapy plus androgen deprivation therapy group achieved baseline urinary symptoms more rapidly than the radiotherapy group (5 months, p = 0.002). On multivariate analysis time to return to baseline in any of the 6 health related quality of life domains was not significantly affected by adding androgen deprivation therapy. Factors associated with longer time to return to baseline mental composite scores on multivariate analysis included nonwhite ethnicity, cerebrovascular disease history and alcohol abuse history. Men treated with permanent brachytherapy monotherapy experienced longer time to return to baseline for urinary function and symptoms. Baseline sexual function and lack of a partner were associated with longer time to sexual recovery. CONCLUSIONS Adding androgen deprivation therapy to definitive radiotherapy does not significantly impact the time to return to baseline health related quality of life. These data may be valuable for patients and physicians when weighing the toxicity and benefits of androgen deprivation therapy when added to definitive radiotherapy.
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Affiliation(s)
- Jonathan D Grant
- Department of Radiation Oncology, University of California-Los Angeles School of Medicine, Los Angeles, California 90095, USA
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Prostate specific antigen bounce is related to overall survival in prostate brachytherapy. Int J Radiat Oncol Biol Phys 2011; 82:883-8. [PMID: 21300477 DOI: 10.1016/j.ijrobp.2010.11.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/12/2010] [Accepted: 11/22/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the association between prostate specific antigen (PSA) bounce and disease outcome after prostate brachytherapy. METHODS AND MATERIALS We analyzed 975 patients treated with (125)I implantation monotherapy between 1992 and 2006. All patients had tumor Stage ≤ 2c, Gleason score ≤ 7 prostate cancer, a minimum follow-up of 2 years with at least four PSA measurements, and no biochemical failure in the first 2 years. Median follow-up was 6 years. Bounce was defined as a PSA elevation of +0.2 ng/mL with subsequent decrease to previous nadir. We used the Phoenix +2 ng/mL definition for biochemical failure. Additional endpoints were disease-specific and overall survival. Multivariate Cox regression analysis was performed to adjust for potential confounding factors. RESULTS Bounce occurred in 32% of patients, with a median time to bounce of 1.6 years. More than 90% of bounces took place in the first 3 years after treatment and had disappeared within 2 years of onset. Ten-year freedom from biochemical failure, disease-specific survival, and overall survival rates were, respectively, 90%, 99%, and 88% for the bounce group and 70%, 93%, and 82% for the no-bounce group. Only 1 patient (0.3%) died of prostate cancer in the bounce group, compared with 40 patients (6.1%) in the no-bounce group. Adjusted for confounding, a 70% biochemical failure risk reduction was observed for patients experiencing a bounce (hazard ratio 0.31; 95% confidence interval 0.20-0.48). CONCLUSIONS A PSA bounce after prostate brachytherapy is strongly related to better outcome in terms of biochemical failure, disease-specific survival, and overall survival.
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Hinnen KA, Roeloffzen EMA, Battermann JJ, Van Moorselaar RJA, van Roermund JG, van Vulpen M. Survival after prostate brachytherapy in patients aged 60 years and younger. BJU Int 2010; 107:1906-11. [DOI: 10.1111/j.1464-410x.2010.09769.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Qualité de vie après radiothérapie pour un cancer localisé de la prostate. Cancer Radiother 2010; 14:519-25. [DOI: 10.1016/j.canrad.2010.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/04/2010] [Indexed: 01/05/2023]
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Roeloffzen EMA, Monninkhof EM, Battermann JJ, van Roermund JGH, Moerland MA, van Vulpen M. Acute urinary retention after I-125 prostate brachytherapy in relation to dose in different regions of the prostate. Int J Radiat Oncol Biol Phys 2010; 80:76-84. [PMID: 20605364 DOI: 10.1016/j.ijrobp.2010.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/07/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the influence of dose in different prostate regions, and the influence of anatomic variation on the risk of acute urinary retention (AUR) after I-125 prostate brachytherapy. METHODS AND MATERIALS In this case-control study, dosimetry and anatomy were compared between 50 patients with AUR (cases) and 50 patients without AUR (controls). Cases and controls were randomly selected from our database. The following structures were delineated on magnetic resonance imaging: prostate, urethra, peripheral zone, transitional zone, apex, base, midprostate, lower sphincter, and bladder neck. The dosimetric parameters analyzed were D(10), D(50), D(90), V(100), V(150), and V(200). The anatomic parameters analyzed were prostate protrusion into the bladder, bladder overlap, urethra angle, and urethra-bladder angle. The delineator was blinded to the patient's AUR status. Logistic regression analysis was used to investigate the association of these factors with AUR. RESULTS The dose delivered to different regions of the prostate was not significantly associated with the risk of AUR. Only dose to the bladder neck was significantly associated with AUR (odds ratio 1.13 per 10 Gy; 95% CI 1.02;1.26; p = 0.023). Mean bladder neck D(90) was 65 Gy in AUR cases vs. 56 Gy in controls (p = 0.016), and mean bladder neck D(10) was 128 Gy vs. 107 Gy, respectively (p = 0.018). Furthermore, on univariate analysis, a larger extent of both bladder overlap and of prostate protrusion were associated with a higher risk of AUR (odds ratio 1.16; 95% CI 1.04-1.28; p = 0.005, and odds ratio 1.83; 95% CI 1.37-2.45; p < 0.001, respectively). The mean extent of prostate protrusion was 3.5 mm in AUR cases vs. 1.0 mm in controls (p < 0.001). Odds ratios did not change substantially after adjustment for potential confounders. On multivariate analysis, the extent of prostate protrusion seemed to be a stronger risk factor for AUR than bladder overlap. CONCLUSION The risk of AUR is not associated with dose delivered to different regions of the prostate. However, a higher dose to the bladder neck and a larger extent of prostate protrusion into the bladder are risk factors for the development of AUR after I-125 prostate brachytherapy.
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Affiliation(s)
- Ellen M A Roeloffzen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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