Postprostatectomy Radiotherapy Timing and Long-Term Health-Related Quality of Life
Authors: Patel Sagar A. , Patil Dattatraya , Smith Joseph , Saigal Christopher S. , Litwin Mark S. , Hu Jim C. , Cooperberg Matthew R. , Carroll Peter R. , Klein Eric A. , Kibel Adam S. , Andriole Gerald L. , Han Misop , Michalski Jeff M. , Wood David P. , Hembroff Larry A. , Spratt Daniel E. , Wei John T. , Sandler Howard M. , Hamstra Daniel A. , Pisters Louis , Kuban Deborah , Regan Meredith M. , Wagner Andrew , Crociani Catrina M. , Kaplan Irving , Sanda Martin G. , Chang Peter ,   PROST-QA/RP2 Consortium, Dunn Rodney , Northouse Laurel , Greenfield Thomas , Ciezki Jay , Dahl Douglas , Zietman Anthony , Feng Felix , Skolarus Ted , Davis Kyle , Stork Linda , Mahadevan Arul 
Published: October 2024

ImportanceThe association between radiotherapy (RT) timing after radical prostatectomy and long-term patient-reported health-related quality of life (HRQOL) in men with prostate cancer is unknown.ObjectiveTo measure long-term HRQOL in men with prostate cancer up to 15 years after prostatectomy with or without RT and examine whether early vs late postprostatectomy RT is associated with differences in sexual, urinary, and bowel HRQOL.Design, Setting, and ParticipantsA prospective, multicenter, longitudinal cohort analysis using HRQOL data from the PROST-QA (2003-2006) and RP2 consortium (2010-2013) studies was conducted. Men with localized prostate cancer undergoing radical prostatectomy were included. Data were analyzed between May 8, 2023, and March 1, 2024. The study was conducted in 12 high-volume academic medical centers in the US.ExposuresMen were stratified based on receipt and timing of postprostatectomy RT: prostatectomy only, early RT (&amp;lt;12 months), and late RT (≥12 months).Main Outcomes and MeasuresLongitudinal sexual, incontinence, urinary irritation, bowel, and hormonal/vitality HRQOL were measured via the Expanded Prostate Cancer Index Composite at baseline; months 2, 6, and 12; and annually thereafter. Treatment groups were compared using multivariable linear mixed-effects models of change in longitudinal domain scores. Pad use for incontinence was measured longitudinally among men receiving postprostatectomy RT.ResultsA total of 1203 men were included in the study: prostatectomy only (n = 1082), early RT (n = 57), and late RT (n = 64). Median age for the entire cohort was 60.5 (range, 38.8-79.7) years, and 1075 men (92.0%) were White. Median follow-up was 85.6 (IQR, 35.8-117.2) months. Compared with men receiving prostatectomy alone, those receiving postprostatectomy RT had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL. However, timing of postprostatectomy RT, specifically early vs late, was not associated with a long-term decrease in any HRQOL domain. There was evidence of improved recovery of sexual, continence, and urinary irritation scores among men receiving early RT compared with those receiving late RT after prostatectomy. Before the start of postprostatectomy RT, 39.3% of men in the early RT cohort and 73.4% of men in the late RT cohort were pad-free. By the sixth visit post-RT, 67.4% in the early RT cohort and 47.6% in the late RT cohort were pad-free.Conclusions and RelevanceIn this multicenter, prospective analysis, postprostatectomy RT appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy RT may result in similar long-term HRQOL outcomes.