Long-Term Health-Related Quality of Life in Men Treated with 125I Prostate Brachytherapy for Clinically Localized Prostate Cancer

Purpose/Objective: 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 quality-of-life instruments. Materials/Methods: A total of 295 men consecutively treated in a single medical center between June 1998 and December 2003 were mailed two standardized 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 after treatment was 12 month (mean 50.3 months; range 12–78 months). 106 (45,9%) men have also been treated with hormonal therapy. Results: A total of 231 questionnaires were returned (78.3% response rate), 221 were suitable for analysis, 12.9% of the patient had died. 76.7% of group 1 and 73.2% of group 2 reported that they were in good, very good, or excellent health. Table 1 provides an overview of the QoL outcomes and side effects. 53.5% (group 1) and 70.7% (group 2) referred strong or moderate pollakisuria, 39.2% reported nocturia, without relevant differences between both groups, and 5.5% of patients suffered from strong or moderate dysuria (p>0.05). 2.3% patients reported strong stress incontinence; 24.7% reported moderate, and 22.0% strong urge incontinence. A total of 13% used pads. There was no evidence of severe rectal dysfunction. 75.6% (group 1) and 60.9% (group 2) had sex during the last four weeks. The most common problems were erectile dysfunction (48.6% vs. 75%, p<0.001) and decrease in ejaculation (39.4% vs. 59.6%, p<0.001). Whereas sexual complaints were age associated, this was not the case for urinary and bowel complaints. Most patients (95.9%) would recommend (125)I seed brachytherapy to others.Table 1Quality of life outcomes, frequency of multi-item incontinence, bowel and sexual function scores* Men with sexual activity over past 4 weeks. * Men with sexual activity over past 4 weeks. Conclusions: Our data substantiate the favorable long-term QoL outcomes associated with modern brachytherapy techniques. Significant age differences were observed in all quality of life measures, with the largest occurring in sexual and urinary symptoms. Sexual function was significantly worse in patients 65 years of age and older (p <0.05).