Patient-reported Quality of Life After Proton Beam Therapy for Prostate Cancer: The Effect of Prostate Size

Anuj Goenka; Neil B Newman; Hiral Fontanilla; Oren Cahlon; Brian Chon; Henry Tsai; Eugen Hug; Carl Brown; Carlos Vargas; Rahul R Parikh

doi:10.1016/j.clgc.2017.03.005

Patient-reported Quality of Life After Proton Beam Therapy for Prostate Cancer: The Effect of Prostate Size

Clin Genitourin Cancer. 2017 Dec;15(6):704-710. doi: 10.1016/j.clgc.2017.03.005. Epub 2017 Mar 18.

Authors

Affiliations

¹ Department of Radiation Medicine, Northwell Health, New Hyde Park, NY. Electronic address: anuj.goenka@gmail.com.
² Department of Radiation Medicine, Northwell Health, New Hyde Park, NY.
³ Department of Radiation Oncology, Princeton Radiation Oncology, Monroe, NJ.
⁴ Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.

PMID: 28412047
DOI: 10.1016/j.clgc.2017.03.005

Abstract

Background: In the present study, we assessed the effect of prostate gland size on patient-assessed genitourinary and gastrointestinal (GI) quality of life (QOL) after definitive treatment of prostate adenocarcinoma with proton beam therapy.

Patients and methods: As a part of a prospective outcome tracking protocol, 81 patients treated at a single center between with proton beam therapy completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before treatment and at the follow-up examinations. We reviewed the dosimetric data, reported as V_x (volume of organ receiving x Gy), and patient-reported QOL at 6 months. Genitourinary QOL was assessed using the American Urological Association symptom score and EPIC urinary domain score. GI QOL was assessed using the EPIC GI domain score.

Results: Larger prostate glands were associated with greater bladder V₇₀ (P < .01) and rectal V₇₀ (P < .01). The rectal V₇₀ was < 15% for all patients (range, 4%-13.8%) with the planned treatment volume coverage (percentage of the prescription dose covering 95% of the volume > 95%) maintained. Patients with larger prostates did not have a greater change in their American Urological Association symptom index scores (< 30 cm³, +2.3; 30-49 cm³, +3.2; ≥ 50 cm³, 0.2; P = .06) or urinary domain score (< 30 cm³, -3.6; 30-49 cm³, -3.1; ≥ 50 cm³, +3.8; P = .76) at 6 months after treatment. Also, prostate size was not associated with a change in the EPIC GI domain score at 6 months after treatment (< 30 cm³, -3.7; 30-49 cm³, -1.1; ≥ 50 cm³, -0.55; P = .67).

Conclusion: Definitive proton beam therapy for prostate cancer to a dose of 79.2 Gy resulted in excellent patient-reported urinary and GI QOL, independently of the baseline prostate size. This single-institution finding should be tested further in a multi-institutional study to confirm the potential limited role of androgen deprivation therapy.

Keywords: Androgen deprivation therapy; Prostate cancer; Proton therapy; QOL; Radiation therapy.

MeSH terms

Dose Fractionation, Radiation
Humans
Male
Prospective Studies
Prostate / pathology*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / psychology
Prostatic Neoplasms / radiotherapy*
Proton Therapy / methods*
Quality of Life / psychology*
Surveys and Questionnaires
Treatment Outcome