Deferred vs early radiotherapy: Which is better at improving QOL after radical prostatectomy?

Deferred radiotherapy (RT) following radical prostatectomy (RP) improves short-term health-related quality of life (HRQOL) better than early RT, a study has shown.

The authors included a total of 4,511 patients in the analysis using the following eligibility criteria: ≥pT3, International Society of Urological Pathology grade ≥4, or positive surgical margin. They also conducted a 1:4 propensity score-matched analysis of 1,599 patients (early RT, ≤6 months after RP: n=307; deferred RT, >6 months after RP).

General HRQOL, based on the European Organisation for Research and Treatment of Cancer QLQ-C30, was the primary endpoint. The authors estimated the impact of RT timing on HRQOL using Pearson correlation and binary logistic regression models, and assessed functional outcome using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires. Median follow-up was 38 months.

At 12 and 24 months, general HRQOL scores were significantly higher for deferred vs early RT (12 months: 52.7 vs 35.5; p=0.001; 24 months: 45.8 vs 37.3; p=0.026). On the other hand, ICIQ-SF scores (12 months: 8.5 vs 6.1; p=0.001; 24 months: 8.4 vs 7.3; p=0.038) were higher and IIEF-5 scores lower (12 months: 1.8 vs 4.2; p=0.001; 24 months: 2.2 vs 4.4; p=0.005) for early vs deferred RT.

Multivariate analysis showed the superiority of deferred RT in terms of general HRQOL at 12 months (odds ratio [OR], 0.59, 95 percent confidence interval [CI], 0.37–0.94; p=0.027) and 24 months (OR, 0.64, 95 percent CI, 0.39–0.99; p=0.043). Additionally, a longer time interval between RP and RT correlated with improved general HRQOL (OR, 1.09, 95 percent CI, 1.038–1.143; p<0.001).

“Since longer time intervals between RP and RT predict better short-term HRQOL, our data provide further support for the concept of deferred RT at low prostate-specific antigen recurrence,” the authors said.