J. A. Clark

Patient-reported symptoms after primary therapy for early prostate cancer: results of a prospective cohort study.

PURPOSEnTo assess complications of therapy for early (nonmetastatic) prostate cancer.nnnPATIENTS AND METHODSnA prospective study of a cohort of 279 men who sought treatment advice and completed required pretreatment forms. The measures were self-reported patient symptoms and other measures of quality of life before therapy and at 3 and 12 months afterward.nnnRESULTSnBowel and bladder symptoms were uncommon pretreatment. Patients frequently reported irritative bowel and bladder symptoms at 3 months after radiotherapy, although these subsided somewhat at 12 months. Substantial (a lot) urinary incontinence and wearing of absorptive pads were reported by 11% and 35% at 12 months after surgery and varied little by age. Incontinence occurred after radiotherapy infrequently, and only in men more than 65 years old. Inadequate erections, present in one third of men pretreatment, were nearly universal at 3 months after surgery, although some improvement, primarily in men under 65 years of age, was evident at 12 months. Sexual dysfunction after radiotherapy increased less but continually through 12 months, suggesting that observed treatment-related differences would decline with further follow-up.nnnCONCLUSIONnExternal-beam radiotherapy of early prostate cancer is followed by bowel and bladder irritability, by increasingly severe sexual dysfunction and, in men aged more than 65 years, occasional urinary incontinence. Greater sexual dysfunction and urinary incontinence occur in the year following radical prostatectomy. These postsurgical complication rates from patient questionnaires are greater than have been reported in other treatment series and confirm the results of two retrospective studies of patient-reported complications.

Does prostate brachytherapy that avoids the central zone prevent long-term urinary incontinence? Five-year results of a multi-institutional comparative cohort study.

4665 Background: To evaluate a prostate brachytherapy technique (XBT) designed to reduce urinary dysfunction by avoiding central prostate radiation, we prospectively compared outcomes of XBT patients to 2 standard technique (SBT) groups.nnnMETHODSnWe surveyed newly diagnosed, untreated patients with clinically localized prostate cancer before brachytherapy to gather clinical and quality of life information, with follow-up 1, 3, 12, 24, 36, 48 and 60 months after treatment. XBT treatment was at Brigham and Womens Hospital, SBT at Beth Israel-Deaconess or Metrowest Hospitals or at Massachusetts General Hospital.nnnRESULTSnAs of December 2010, 263 enrolled patients with at least 3-month follow-up, including 73 XBT patients and 190 SBT patients, 99 at 1 site and 91 at the other, and 167 (63%) had completed 5-year follow-up. Tthe treatment groups were similar before treatment. For all patients, urinary obstruction/irritation was increased for 24 months but rose less and resolved earlier for XBT patients. One SBT group reported greater urinary dysfunction, but the problem resolved after a technique change. At 60 months after SBT, but not XBT, urinary incontinence appeared to rise (P=0.09). Sexual dysfunction rose for 36 months for all groups but not thereafter.nnnCONCLUSIONSnSharply reduced periurethral radiation suppresses post-treatment increases in urinary obstruction/irritation and may prevent long-term urinary incontinence, although definitive results may require longer follow-up. Declining sexual dysfunction appears to halt after 36 months.

Using patient-reported outcomes to assess prostate brachytherapy technique

4697 Background: Brachytherapy technique may affect prostate cancer treatment outcomes. One attempts to reduce urinary dysfunction by excluding the periurethral transitional zone from the target volume using MRI localization (MRB). In a small study, we found less short-term urinary and sexual function in patients after MRB, but worse bowel function. To assess the affect of technique, we compared patient-reported outcomes after MRB with those in 2 different academic practices using ultrasound and conventional target volumes (USB). Methods: In an ongoing cohort study, we surveyed patients with validated instruments to measure treatment-related urinary, bowel and sexual dysfunction before treatment (BL) and at 3 and 12 months. We abstracted clinical data from medical records. We report 12-month follow-up results. Results: Other than age, MRB and USB patient groups had similar favorable pretreatment demographic and clinical characteristics. MRB patients tended to increase urinary dysfunction less and bowel dy...

Treatment “mismatch” in early prostate cancer: An empirical measure of patient-physician communication

4566 Background: Because complications vary by treatment, preexisting organ dysfunction may relatively contraindicate specific treatment modalities for early prostate cancer. However, dysfunction may not be fully communicated between patient and doctor. We compared patient-reported pretreatment dysfunction with the treatment modality received to empirically assess this process.nnnMETHODSnIn a prospective, 438-patient cohort study, we determined how often patients with intermediate and poor urinary, sexual, and bowel function received relatively contraindicated brachytherapy (BT), nerve sparing radical prostatectomy (NSRP), or external beam radiotherapy (EBRT) respectively. Because age affects treatment choice, we assessed receipt of contraindicated (i.e.,mismatched) BT in all men, NSRP in men ≤ 65 years, and EBRT in men >65 years. To assess the actual impact of mismatched treatments, we analyzed functional outcomes.nnnRESULTSnOverall, 242 patients reported intermediate to poor baseline urinary, sexual, and/or bowel function; 50 patients (21%) received mismatched treatments. Of 196 patients in our cohort with baseline urinary obstructive/irritative symptoms, 28 (14%) received BT (see table). Of 83 patients 65 years old or younger with intermediate or poor baseline sexual function, 17 (20%) received NSRP. Of 213 patients older than age 65, 7 had baseline bowel dysfunction, but 5 (71%) received EBRT. Mismatched patients tended to have greater increases in dysfunction, although small sample sizes limited analysis.nnnCONCLUSIONSnPatients reporting dysfunction received relatively contraindicated treatment modalities surprisingly often. While multiple factors affect treatment decisions, incomplete patient-physician communication regarding baseline patient dysfunction may compromise the quality of care. [Figure: see text] No significant financial relationships to disclose.