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Health Outcomes After External-Beam Radiation Therapy for Clinically Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study

From the Keck School of Medicine of the University of Southern California, Department of Preventive Medicine, Los Angeles, CA; Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Urology, University of Connecticut Health Center, Farmington, CT; Division of Urology, University of Utah School of Medicine, Salt Lake City, UT; Medicine Service, Department of Veterans Affairs Medical Center and New Mexico Tumor Registry, Albuquerque, NM; Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA; and Applied Research Program, National Cancer Institute, Bethesda, MD.

Address reprint requests to Ann S. Hamilton, PhD, Keck School of Medicine of the University of Southern California, Department of Preventive Medicine, 1441 Eastlake Ave, Room 3427, MC 9175, Los Angeles, CA 90089-9175; email: ahamilt{at}hsc.usc.edu

PURPOSE: Studies reporting effects of radiotherapy for prostate cancer on sexual, bowel, and urinary function have been conducted primarily in referral centers or academic institutions. Effects of external-beam radiotherapy for prostate cancer among a population-based cohort were assessed.

PATIENTS AND METHODS: The study population included 497 white, Hispanic, and African-American men with localized prostate cancer from six US cancer registries who were diagnosed between October 1, 1994, and October 31, 1995, and treated initially with external-beam radiotherapy. They were interviewed at regular intervals, and medical records were reviewed. Distributions of responses for bowel-, urinary-, and sexual-related functions at 6, 12, and 24 months after diagnosis and adjusted mean composite change scores for each domain were analyzed.

RESULTS: Declines of 28.9% in the sexual function score and 5.4% in the bowel function score occurred by 24 months, whereas at this time, the urinary function score was relatively unchanged. A total of 43% of those who were potent before diagnosis became impotent after 24 months. More than two thirds of the men were satisfied with their treatment and would make the same decision again.

CONCLUSION: Sexual function was the most adversely affected quality-of-life domain, with problems continuing to increase between 12 and 24 months. Bowel function problems increased at 6 months, with partial resolution observed by 24 months. Despite the side effects, satisfaction with therapy was high. These results are representative of men in community practice settings and may be of assistance to men and to clinicians when making treatment decisions.

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