Prospective Assessment Of Urinary, Gastrointestinal, And Sexual Symptoms Before, During, And After Image-Guided Intensity Modulated Radiation Therapy For Prostate Cancer

Image guided intensity modulated radiation therapy (IG-IMRT) promises the delivery of a very precise radiation dose with reduced toxicity. The purpose of this study was to prospectively assess the urinary, gastrointestinal (GI) and sexual symptoms in patients with prostate cancer (PCa) before, during and after IG-IMRT. A total of 91 consecutive patients with PCa participated in this prospective questionnaire survey. There were 77 patients with high risk disease and 14 patients with intermediate risk disease. The median age was 67 (range 50-75). The patients completed the Prostate Cancer Symptom Scale (PCSS) questionnaire before RT (baseline), at the start of RT, at the end of RT and one year after RT. The PCSS questionnaire contains 24 scale questions about specific urinary, GI and sexual symptoms. The questions are answered on a linear scale from 0 to 10, where 0 corresponds to “none” and 10 corresponds to “a high degree”. The RT was delivered as Volumetric Modulated Arc Therapy (VMAT) with daily image guidance based on implanted fiducial markers and with PTV margins of 5-7 mm. The dose was 78 Gy. The mean changes in symptom scores at the start of RT, at the end of RT and one year after RT compared to baseline were analyzed by a mixed model analysis of repeated measurements. A change in score of 0.5-1.0 was perceived as a small change, 1.0-2.0 as moderate and above 2.0 as large. All urinary symptoms except hematuria worsened significantly at the end of RT compared to baseline. The worst deteriorations were observed in painful urination (mean change: 3.3 ([2.6-3.9]) and overall urinary bother (2.8 [2.1-3.6]). However, one year after RT all urinary symptoms had returned to the baseline levels. All GI symptoms, except nausea, worsened significantly at the end of RT compared to baseline. One year after RT, patients also experienced mild to moderate deteriorations in frequency (0.9 [0.5-1.2]), leakage (0.4 [0.0-0.8]), need to plan toilet visits (1.5 [0.9-2.0]), flatulence (1.1 [0.6-1.7]), mucus (0.9 [0.4-1.4]), rectal bleeding (0.4 [0.1-0.6]) and impact of GI bother on daily activities (1.0 [0.5-1.5]) compared to baseline. ADT was associated with less nausea and mucus. All sexual symptoms deteriorated significantly at all times compared to baseline. ADT was highly associated with increased sexual symptoms. IG-IMRT is a safe treatment for PCa with few and mild changes in urinary and GI symptoms one year after RT compared to baseline. Sexual symptoms worsened significantly both during and after RT and were highly influenced by the use of ADT.