Post-treatment changes in bowel and urinary function in prostate cancer patients treated with moderate or ultra-hypofractionation: A prospective cohort study

Objective/Purpose: 

Hypofractionation (HF) has been established as safe in prostate cancer (PCa) trial populations. We evaluated post-treatment changes in health-related quality of life (HRQoL) outcomes after moderate (MHF) or ultra-hypofractionated (UHF) radiotherapy in a real-world PCa patient population. 

Methods: 

In this prospective cohort study, T1-4N0M0 PCa patients receiving MHF (20x3/3.1 Gy, n = 140) or UHF (7x6.1 Gy, n = 138) were assessed. UHF was not prescribed in case of T3b/T4 disease or an impaired baseline urinary function. Patients completed the EPIC urinary and bowel domains and the EQ-5D-5L (general HRQoL) at baseline and 6 months post-treatment. Thresholds for minimal clinically important differences (MCID) were defined at 8 %. Prognostic factors were assessed using regression models. 

Results: 

Proportion of the total cohort with MCID deterioration for bowel and urinary function was 20 % and 17 %, respectively. Deteriorations in bladder and bowel function significantly correlated with declined scores for general health, usual activities, pain/discomfort, and depression/anxiety. Predictive factors for urinary function deterioration at multivariable analysis were androgen deprivation therapy, age ≥ 75 year, MHF, and grade ≥ 2 acute urinary toxicity. For bowel function deterioration, no factors were identified.

Conclusion: 

We assessed post-treatment changes in HRQoL in a clinical PCa patient population treated with MHF and UHF, and observed changes comparable to previous trial reports. Deteriorations in bowel and urinary function correlated with worse general health scores. Results for urinary function loss suggested a consequential effect of acute urinary toxicity.