Radiotherapy in prostate cancer : information, quality of life and prostate volume

Sammanfattning: Prostate cancer (PC) is the most widespread form of cancer among men in Sweden, with an annual incidence of approximately 10,000 new cases. Treatment of localized prostate cancer is controversial. Curative intended treatments for localized disease include radical prostatectomy (RP) and radiotherapy (RT). These treatments considered to be equally effective, but have different side effects. ADT commonly used as neo-adjuvant therapy in curative intended radiotherapy. The various regimens of ADT have different side effect profiles. Thus, patients need information about how the different side effects might influence their health-related quality of life (HRQoL), both concering primary treatment (RP and RT) and about ADT. Providing adequate information to cancer patients facilitate their adjustment to the cancer experience by increasing perceptions of control, reducing feelings of threat and anxiety, and in improving HRQoL.Thus, it is of importance to investigate satisfaction with information in prostate cancer patients treated with curative intention. The aims of Paper 1, were to compare information perception and satisfaction with that and influence on HRQoL in patients primarily treated with RT alone or with salvage RT after failure of RP. Using the EORTC QLQ C-30 and EORTC INFO 25 questionnaires in 660 patients prospectively. Higher levels of satisfaction with information and more favorable HRQoL were found in patients treated with RT primarily compared to surgery + salvage RT. In Paper 2, the aims were to compare HRQoL of RT and RP in a randomized trial of 89 patients in curative setting. EORTC QLQ C-33 questionnaire and 20 specific questions were asked by mailed questionnaires. No differences between the two treatments were found. It was not possible to draw any conclusion about efficacy of the treatments due to insufficient power of the study. In Paper 3, the aims were to compare differences in HRQoL after randomizing antiandrogen versus total androgen blockade in 110 curative intent RT patients. EORTC QLQ C-30 and EORTC QLQ PR25 were used. Statistically significant differences in sexual interest and function were noted, in favour of anti-androgen treated patients. In addition, higher levels of overall quality of life and sexual interest as well as lower levels of fatigue, and urinary problems were found at the three-months assessment in the antiandrogen group compared to the total androgen blockade group. The difference in sexual interest remained to the 18-months assessment. At that point of time, significant difference favoring the anti-androgen group found in cognitive functioning. In Paper 4, the aims were to compare differences in changes of prostate volume and in target volume in patients included in Paper 3. Ultrasound technique was used to investigate differences in PV after neo-adjuvant hormonal therapy according to randomization arm. Total androgen blockade was more effective in decreasing PV. This effect was translated to target volume. PV increased during treatment in a few patients in both groups. Conclusion: Information is important for PC patients´ HRQoL and there is room for improvement, especially for men who are about to receive salvage radiotherapy. No differences in HRQoL were found between PC patients treated with RP or RT. The study was, however, underpowered. Anti-androgen treatment resulted in better HRQoL in the short run as compared to total androgen blockade. Largest effects were noted in the sexual area. Total androgen blockade had a better effect on decreasing prostate volume.