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Health-Related Quality of Life Results in Pathologic Stage C Prostate Cancer From a Southwest Oncology Group Trial Comparing Radical Prostatectomy Alone With Radical Prostatectomy Plus Radiation Therapy

Carol M. Moinpour, Katherine A. Hayden, Joseph M. Unger, Ian M. Thompson, Jr, Mary W. Redman, Edith D. Canby-Hagino, Betsy A. Higgins, Jerry W. Sullivan, Dianne Lemmon, Sheila Breslin, E. David Crawford

From the Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA

Corresponding author: Carol M. Moinpour, PhD, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, M3-C102, 1100 Fairview Ave North, Box 19024, Seattle, WA 98109-1024; e-mail: cmoinpou{at}fhcrc.org

Purpose To compare short- and long-term effects of adjuvant treatment versus observation after surgery on health-related quality of life (HRQL) of prostate cancer patients.

Patients and Methods The Southwest Oncology Group (SWOG) intergroup trial compared radical prostatectomy (RP) plus observation versus RP plus adjuvant radiation therapy (RT). Two-hundred seventeen of 425 therapeutic trial patients were eligible and registered to the HRQL study. Patients completed the SWOG Quality of Life Questionnaire (emotional, physical, social, and role function; general symptom status; treatment/disease-specific symptoms; and global HRQL [GHRQL]) at baseline, 6 weeks, 6 months, and annually for 5 years. Prespecified outcomes were three genitourinary symptoms (bowel function tenderness, frequent urination, and erectile dysfunction [ED]) and measures of physical and emotional function. Adjustments were made for the baseline score.

Results Patients receiving adjuvant RT reported worse bowel function (through approximately 2 years) and worse urinary function. There were no statistically significant differences for ED. GHRQL was initially worse for the RP+RT arm but improved over time and was better at the end of the period than the GHRQL reported for RP alone (treatment arm x time interaction, P = .0004). Symptom distress was significantly worse for the RP+RT arm compared with the RP alone arm, but the treatment arms did not differ with respect to other general measures of HRQL.

Conclusion The addition of RT to surgery resulted in more frequent urination, as well as early report of more bowel dysfunction, although bowel function differences disappeared over the 5-year period. The addition of RT did not negatively impact ED.

Supported in part by the following Public Health Service Cooperative Agreement Grants awarded by the National Cancer Institute, Department of Health and Human Services: CA38926, CA32102, CA14028, CA58416, CA58658, CA42777, CA27057, CA46136, CA35431, CA58882, CA12644, CA58861, CA35090, CA37981, CA76429, CA04919, CA76132, CA35119, CA35178, CA35176, CA46282, CA67575, CA45377, CA46113, CA74647, CA35261, CA04920, CA20319, CA76447, CA58723, CA12213, CA22433, and CA46441.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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