gms | German Medical Science

Purpose: Prostate brachytherapy has been reported to have less morbidity for patients than radical prostatectomy or external beam irradiation. However, information regarding long-term treatment-specific quality-of-life (QoL) is scant. We evaluated the impact of permanent implant brachytherapy on general, cancer specific and symptom domains of QoL for up to 6 years using validated patient-administered QoL instruments.

Methods and Materials: A total of 296 men consecutively treated in a single academic medical center between June 1998 and Dezember 2003 were mailed two standarized questionnaires (the EORTC prostate cancer quality of life questionnaire QLQ-PR25 and the ICS-male questionnaire) to assess health-related QoL. We subclassified two groups of patients: group 1 with patients younger than 65 years of age (n=45, median age 62, range 45-64), group 2 with patients 65 years of age or older (n=186, median age 73, range 65-85). The minimal follow up was 13 months (median 51 months; range 13-78 months). The clinical parameters evaluated included age, pretreatment prostate-specific antigen level, gleason score, and stage. 97 (42%) men have been treated with hormonal therapy.

Results: A total of 238 questionnaires were returned (80.4% response rate), 231 were suitable for analysis, 12.8% of the patient had died. Over all, 77.8% of patients in group 1 and 73.4% of patients in group 2 reported that they were in good, very good or excellent health.53.3% (group 1) and 70.7% (group 2) refered strong or moderate pollakisuria (p<.05). A total of 39.5% reported nocturia; 4.8% suffered from strong or moderate dysuria; 2.2% reported strong stress incontinence; 25.3% reported moderate, and 21.4% strong urgency; 15.2% used pads, without significant differences between both groups. There was no evidence of severe rectal dysfunction. 82.2% (group 1) and 81.2% (group 2) had sex during the last four weeks. The most common problems were erectile dysfunction (51.3% vs. 75%, p<0.01) and decrease in ejaculation (40% vs. 60%, p<0.05). While global sexual functioning was age associated, this was not the case for global urinary and bowel functioning. Most patients (95.5%) would recommend (125)I seed brachytherapy to others.

Conclusions: Our data substantiate the favorable long-term QoL outcomes associated with modern brachytherapy techniques. A significant age difference was observed in global sexual functioning, favoring patients younger than 65 years.