Patients with prostate cancer can live for many years regardless of the treatment they receive due to the long natural history. As a result, HRQoL has become an important outcome measure in patients with this disease. Different survey instruments are designed to assess HRQoL of patients with prostate cancer [3
]. We have conducted our survey by using a modified version of FACT-P (version 3) survey tool [12
] The structure of FACT-P (version 3) survey instrument comprising a 47-item questionnaire, which is divided into four primary QoL domains: physical, social/family, emotional, and functional well-being, plus a 12-item prostate cancer subscale. These 12-items ask about symptoms and problems specific to prostate cancer. Higher total scores for the FACT-P scale indicate a better overall QoL. The modified survey instrument has a total of 50 questions and the only modification is in the prostate subscale for the purpose of accommodating symptoms related to radiation induced late toxicity (Table ).
Modified FACT-P Prostate subscale (version3). Questions 47–49 added to the FACT-P Prostate subscale (version3)
Sathya et al
reported a randomized study in which patients with locally advanced prostate cancer were treated with EBRT alone or combination of EBRT and iridium HDRBT. The study showed no difference in the toxicity scores between the two arms at 18 months of follow up [9
]. This study also provided evidence that higher doses of radiation delivered by the combination treatment resulted in better local as well as biochemical control in locally advanced prostate cancer. Other studies have also reported improved local control following dose escalation with 3D-CRT or IMRT [7
]. The risks of long-term morbidity, following dose escalation by various methods are incompletely understood yet and they could have a significant impact on post treatment QoL.
Various studies have demonstrated the significance of HRQoL assessment when considering different treatment options for prostate cancer and suggested that recommended treatment decisions should take into account HRQoL in addition to survival [12
]. Wei et al
reported a comparative HRQoL outcome study for patients with localized prostate cancer who underwent brachytherapy, radical prostatectomy or EBRT [14
]. Higher FACT-P scores were reported in patients treated with EBRT than with brachytherapy. The authors concluded that the HRQoL changes are likely to be treatment-specific. Welsh et al
compared the baseline to six months post treatment QoL of 10 patients with prostate cancer treated with EBRT plus HDRBT [15
]. They found that the median QoL scores were comparable to baseline values at six months and concluded that EBRT plus HDRBT is an acceptable treatment when QoL is considered.
Our study compared HRQoL among patients with localized prostate cancer who had undergone radical treatment using the two different radiation techniques. Our findings indicated that both groups had similar QoL outcomes at the end of one year of treatment. Vordermark D et al
reported the results of a similar study among 84 prostate cancer patients treated with either EBRT alone or EBRT plus HDRBT [16
]. The study showed comparable QoL data between the two groups at a median duration of 19 months post treatment. HRQoL differences may not become apparent at the end of one to two years of completion of treatment and hence a longer follow up might be helpful to see the difference. Wahlgren T et al
reported the five year disease-specific HRQoL of patients with localized prostate cancer following combined treatment including EBRT, HDRBT and hormone therapy [17
]. The long term data reported that only minor differences in general HRQoL compared with normative data. We are in the process of reviewing HRQoL of our patients at five years post treatment.
Our data may have significant implications. While offering curative radiation treatment, most of the patients are interested to know how the different treatments compare to one another in terms of survival, long term morbidity and HRQoL. Our study showed the significance of the evaluation of QoL which would help both patients and physicians to make more informed decisions between different treatment techniques.
A potential limitation of our study is that this is a single-institutional non-randomised study with a small sample size in the EBRT plus HDRBT arm. In addition the study lacks baseline HRQoL information. Radiation doses are also low by today's standards. However the study does help to minimise concerns of using combination treatment as an alternative for dose escalation when QoL is considered.