Quality of Life After Prostate Cancer Treatment
Authors: W. Robert Lee, Martin G. Sanda, P. William McLaughlin
Journal: Journal of Clinical Oncology (2002)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2002.20.13.3038 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12089237 Quality of Life After Prostate Cancer Treatment W. Robert LeexW. Robert LeeSearch for articles by this author Martin G. SandaxMartin G. SandaSearch for articles by this author , P. William McLaughlinxP. William McLaughlinSearch for articles by this author Show More Wake Forest University School of Medicine, Winston Salem, NCUniversity of Michigan Medical Center, Ann Arbor, MI https://doi.org/10.1200/JCO.2002.20.13.3038 First Page Full Text PDF Figures and Tables © 2002 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01072002In Reply:Dr. Lee’s letter is greatly appreciated and highlights important caveats to our manuscript. Principal among these is that selection criteria may vary between different institutions, thereby limiting the generalizability of any single institution’s experience with early-stage prostate cancer intervention, irrespective of whether the intervention is surgery, external radiation, or brachytherapy. Selection criteria for brachytherapy have undergone evolution since the period (1995 to 1999) when patients described in our cohort were treated, and brachytherapy techniques have been refined as well. It is possible that such improvements may lead to better health-related quality-of-life (HRQOL) outcomes.Baseline function can reflect such evolving selection criteria, and therefore, prospective studies such as that reported by Lee et al1,2 provide an important complement to the long-term data reported by cross-sectional studies.3-5 Multi-institutional prospective studies and randomized clinical trials are the rational next step. Toward this goal, the Surgical Prostatectomy Interstitial Radiation Intervention Trial from the American College of Surgeons Oncology Group has been opened and will directly compare outcomes between patients randomized to prostatectomy versus brachytherapy. Trials to randomize subjects between brachytherapy alone versus brachytherapy combined with external radiation are under development by the Radiation Therapy Oncology Group. Perhaps the most relevant and durable observation from Wei et al5 is that such trials need to evaluate a spectrum of HRQOL domains that should include urinary irritative and hormonal concerns in addition to the previously established domains of urinary incontinence, sexual, and bowel HRQOL.6-7It should be noted that both the International Prostate Symptom Score (IPSS) and Functional Assessment of Cancer Therapy-Prostate (FACT-P) have limited sensitivity in this regard, and neither instrument was developed or validated for evaluating early-stage prostate cancer HRQOL. We reported IPSS and FACT-P scores only to provide context for our findings, as evidence suggesting that our observations were not outside of the range of possible expected results. Whether or not the posttherapy IPSS scores we observed (mean IPSS = 12.6 at 21 months) are substantially different from those observed by Lee et al2 (IPSS = 13.7 at 6 months and 10.2 at 12 months) is debatable. We feel that more important than a comparison of FACT-P or IPSS scores between studies, however, is the recognition that IPSS and FACT-P have very limited utility for comparing HRQOL effects of different early-stage prostate cancer interventions.1At the time that our subjects received brachytherapy, the utility of baseline IPSS scores as an exclusion criterion for brachytherapy had not been well characterized, and so baseline IPSS score was not used as a selection criterion for therapy. Prostate size was considered, but more than 60 mL was not an absolute contraindication. Higher activity sources were used than we are currently using. In contrast to current planning margins, implants were planned with a wider margin posterior and below the prostate to ensure adequate coverage of the prostatic apex. These elements may have contributed to the observed HRQOL effects, but represented a high quality standard of brachytherapy in 1995 to 1999. Patients were planned with peripheral loading, and the 160-Gy dose was by the prior convention and equivalent to 145 Gy TG-43. Urethral doses were kept below 240 Gy. 1. Lee WR, Hall MC, McQuellon RP, et al: A prospective quality of life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy. Int J Radiat Oncol Biol Phys 51:: 614,2001-623, Crossref, Medline, Google Scholar2. Lee WR, McQuellon RP, Harris-Henderson K, et al: A preliminary analysis of health-related quality of life in the first year after permanent source interstitial brachytherapy (PIB) for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 46:: 77,2000-81, Crossref, Medline, Google Scholar3. Talcott JA, Clark JC, Stark P, et al: Long-term treatment-related complications of brachytherapy for early prostate cancer: A survey of patients previously treated. J Urol 166:: 494,2001-499, Crossref, Medline, Google Scholar4. Davis JW, Kuban DA, Lynch DF, et al: Quality of life after treatment for localized prostate cancer: Differences based on treatment modality. J Urol 166:: 947,2001-952, Crossref, Medline, Google Scholar5. Wei JT, Dunn RL, Sandler HM, et al: A comprehensive comparison of health related quality of life following contemporary therapies for localized prostate cancer. J Clin Oncol 20:: 557,2002-566, Link, Google Scholar6. Litwin MS, Hays RD, Fink A, et al: Quality-of-life outcomes in men treated for localized prostate cancer [see comments]. JAMA 273:: 129,1995-135, Crossref, Medline, Google Scholar7. Wei JT, Dunn RL, Litwin MS, et al: Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality-of-life in men with prostate cancer. Urology 56:: 899,2000-905, Crossref, Medline, Google Scholar