2484 - Patient Reported Outcomes (PROs) after Radiation Therapy or Surgery followed by Radiation Therapy for Prostate Cancer

Purpose/Objective(s): Definitive treatment strategies in prostate cancer (PCa) can be associated with a spectrum of side effects that can significantly impact patients’ (pts) quality of life (QoL). There is paucity of data for direct comparisons of surgery followed by radiation (SRT) versus radiation (RT) alone. Our objective was to evaluate if RT would be associated with lesser symptoms and favorable PROs compared to SRT.

Materials/Methods: This is an IRB approved retrospective study of nonmetastatic PCa pts treated with RT alone or SRT between 2015-2024. PROs were prospectively collected at baseline, 3 mos, 1 yr, and 3 yrs using the EPIC-26 (Expanded Prostate Cancer Index Composite Short Form). Symptom scores were calculated as means (standardized 0–100) with lower scores indicating worsening of symptoms; meanwhile, increasing QoL scores indicate improvement in function. We compared changes in urinary, bowel, and sexual symptoms; and changes in overall QoL metrics between the two groups using Wilcoxon rank sum test.

Results: Of 5092 consecutive pts, 1219 had baseline EPIC-26 score available for evaluation. Median age was 72 yrs (range 44 – 89). Median dose in RT group was 70.2 Gy (60 – 70.2) in 26 fractions versus 70.2 Gy (68 – 72) in 36 fractions in SRT. Extraprostatic disease was identified in 58% of SRT and 23% pts of the RT only cohort. 38.7% of all pts had high risk disease, while 61.4% had lower NCCN risk categories. The mean urinary incontinence scores indicated worsening of symptoms from baseline in the SRT group at 3 mos (85 vs 70, p <0.0001), 1 yr (82 vs 60, p <0.0001), and at 3 yrs (80 vs 61, p<0.0001). Urinary obstructive/irritative symptoms appeared to be worse for the RT only group at 3 mos (83 vs 89, p<0.0001); however, no statistically significant difference was observed at 1 yr (83 vs 85, p=0.14) and 3 yrs (85 vs 86, p=0.16). The overall urinary QoL function was favorable for RT only group at 1 yr (72 vs 60, p=0.0001); however, no statistically significant difference at 3 yrs (72 vs 67, p=0.10) was noted. The bowel symptom scores were worse for SRT group at 3 mos (88 vs 85, p=0.009) and 1 yr (87 vs 84, p=0.009); however, there was no significant difference at 3 yrs (88 vs 86, p=0.34). The overall bowel QoL function similarly appeared in favor of RT only group at 3 mos (82 vs 77, p=0.006) and 1 yr (80 vs 70, p=0.002), with no statistical difference at 3 yrs (82 vs 79, p=0.20). Sexual symptoms showed numerical worsening of symptoms at all time points in SRT group; however, these were not statistically significant (25 vs 22, p=0.56; 27 vs 25, p=0.69; 30 vs 27, p=0.35). Endocrine symptoms were worse for SRT group at 1 yr (83 vs 77, p=0.01) and 3 yrs (86 vs 79, p=0.0009).

Conclusion: SRT yielded worse symptom scores compared to pts undergoing RT alone with considerable impact on PROs and QoL as early as 3 mos and notable persistent detriment at 1 yr following completion of treatment. These data emphasize the need for judicious selection of definitive treatment modality for PCa pts, as the combined side effects of SRT have greater impact than RT alone.