196 - Comparative Prognostic Value of Disease-Specific Patient-Reported Outcomes in Prostate Cancer

11:45am - 11:55am ET

Room 109

Presenter(s)

Minji Lee, PhD - Mayo Clinic Rochester, Rochester, MN

M. K. Lee¹, K. O. Steinert¹, F. Mastroleo², and M. R. Waddle³; ¹Mayo Clinic, Rochester, MN, ²Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy, ³Department of Radiation Oncology, Mayo Clinic, Rochester, MN

Purpose/Objective(s): Selecting appropriate patient-reported outcome measures (PROMs) remains a key challenge in prostate cancer research and clinical care. EPIC-26 (Expanded Prostate Cancer Index Composite-Short Form) is widely used to measure health-related quality of life in men with prostate cancer, while PRO-CTCAE (PRO Version of the Common Terminology Criteria for Adverse Events) is increasingly integrated into oncology research. This study evaluates the relative predictive performance of these PROMs for overall survival, informing evidence-based PROM selection in prostate cancer.

Materials/Methods:

From 04/29/2015 to 02/05/2025, 3,718 prostate cancer patients treated with radiation therapy contributed PRO-CTCAE data, 3,665 contributed EPIC-26 data, and 3,618 contributed both. Patients completing at least one assessment at baseline, end of treatment, or follow-up (3-month to 2-year) were included. PRO-CTCAE items with frequency (F), severity (S), interference (I), and presence (P) attributes were reverse-coded so higher scores reflected better health, consistent with EPIC-26. PRO-CTCAE item, composite (C) score, and average composite scores (ACS), as well as EPIC-26 item and domain scores, were standardized and entered into time-dependent Cox models adjusted for age, race, ethnicity, and area deprivation index.

Results: Fatigue (S, I, C) and EPIC-26’s lack of energy were the strongest predictors of survival (HRs: all 0.68; all p<0.0001). PRO-CTCAE GI/Urinary function ACS was also strongly predictive (HR: 0.74, p<0.0001). PRO-CTCAE’s loss of bowel control (F, C), pain in abdomen(I), and EPIC-26 sexual function items (quality of erection, ability to reach orgasm) and sexual domain scores were significantly associated with survival (all p<0.0001). In contrast, PRO-CTCAE sexual function ACS and related items such as ejaculation problems (F,C), unable to orgasm (P), decreased sexual interest (S,C) were not predictive of survival. EPIC-26 hormonal (HR:0.78,p<0.0001), urinary incontinence (HR:0.85, p=0.001), urinary irritative/obstructive (HR:0.87,p=0.008), and bowel domain (HR:0.87, p=0.003) scores were significant predictors, while bloody stools (EPIC-26), breast tenderness/enlargement (EPIC-26, PRO-CTCAE), and hot flashes (EPIC-26) were not.

Conclusion: Fatigue was a strong predictor of survival across PROMs. PRO-CTCAE GI and urinary dysfunction items and ACS and all EPIC-26’s domain scores demonstrated prognostic utility, while sexual measures differed between instruments, highlighting similarities and distinctions for PROM predictive performance.