EURURO Vol. 72 No. 6

Versus Interstitial Radiation Intervention Trial (SPIRIT)

[11]

enrolled 168 men with low-risk PCa who received either RP

or LDR BT. The investigators using the EPIC tool found a

statistically significant difference in the urinary and sexual

domain, favouring men treated with LDR BT at a mean

follow-up of 5.2 yr. These results should be interpreted with

caution, since only a minority of patients were randomly

assigned to treatment arms (19%) and the trial was closed

prematurely due to poor accrual.

Another RCT

[13]

that recruited 200 patients with low-

risk PCa reported that urinary irritation was statistically

significantly worse in the LDR BT arm when compared with

pretreatment values, while urinary incontinence was more

common—although not statistically significantly different—

in the nerve-sparing RP (NSRP) arm, at 1 yr of follow-up.

However, there were no significant differences in EORTC

QLQ-C30/PR25 scores at 5-yr of follow-up. It is notable that

only within-group tests were reported in this trial.

3.4.2.

Data from NRCSs

Statistically significant differences, for QoL outcomes

between or within treatment groups, at the latest follow-

up of each NRCS

[14–30]

are shown in

Table 4

. A complete

summary of the outcome results can be found in

Supplementary Table 2.

3.4.2.1. RP versus EBRT versus BT.

An observational study

[25]

compared men undergoing NSRP versus non-NSRP versus

EBRT versus BT using the University of California, Los

Angeles (UCLA) Prostate Cancer Index (PCI) tool. The study

was characterised by poor participant retention at 5 and

10 yr. However, at 2 yr of follow-up (81% cohort retention),

authors using NSRP as a reference value reported that men

treated with EBRT were more likely to have a clinically

significant decline (CSD; at least half standard deviation

from baseline) in bowel function and bother score, while

men treated with BT were more likely to have a CSD in

bowel bother score. Conversely, men were less likely to

have a CSD in urinary and sexual function for BT and EBRT.

These results are analogous with the results from two other

studies

[14,21]

. The first

[14]

used the UCLA-PCI tool, and

for a follow-up of up to 5 yr, reported that patients treated

with EBRT had better sexual and urinary but worse bowel

function than those treated with RP. BT patients had better

sexual function, sexual bother, and urinary function

compared with RP patients; however, they had worse

bowel function, bowel bother, and urinary bother. The

second study

[21]

assessed QoL scores at 3 yr using the EPIC

questionnaire. In comparison with NSRP, EBRT and BT

caused significantly worse urinary irritative/obstructive

adverse effects but less urinary incontinence and sexual

dysfunction. EBRT also caused worse bowel and hormonal

adverse effects.

Sanda et al

[27] ,

using the EPIC tool, compared CSDs in

QoL scores within treatment groups only, from baseline to

2 yr post-treatment. Patients in the RP group reported CSDs

in urinary continence and sexual function; however, urinary

irritation/obstruction scores significantly improved after

surgery. EBRT was also associated with improvement in

Symon

(2006)

[29]

, U

SA,

prospective, NR

Radical

prostatectomy

24 57.5 (7.7)

T1: 13 (56.5%)

T2: 10 (43.5%)

2–6: 12 (50%)

7: 11 (46%)

8–10: 1 (4%)

4–10: 22 (92%)

10: 2 (8%)

EPIC

EBRT

26 61.9 (27)

T1: 19 (76.0)

T2: 6 (24.0)

2–6: 10 (38%)

7: 15 (58%)

8–10: 1 (4%)

4–10: 20 (77%)

10: 5 (19%)

ADT = androgen deprivation therapy; CI = confidence interval; COPD = chronic obstructive pulmonary disease; EBRT = external beam radiotherapy; EPIC = Expanded Prostate Cancer Index Composite; FU = follow-up;

IMRT = intensity-modulated radiotherapy; N = number of patients; N/A = not applicable; NR = not reported; NS = nerve-sparing; PCOS = Prostate Cancer Outcomes Study; PROM = patient-reported outcome measure;

SBRT = stereotactic body radiotherapy; SD = standard deviation; UCLA-PCI = University of California, Los Angeles Prostate Cancer Index.

Watchful waiting and hormonal arms of the study have been excluded from this review.

Active surveillance arm of the study has been excluded from this review, as authors did not distinguish between watchful waiting, active surveillance, and treatment delay.

The study reports only 12 mo FU results.

Cryotherapy arm of the study has been excluded from this review.

Watchful waiting/active surveillance and ADT arms of the study have been excluded from this review.

Expectant management arm of the study have been excluded from this review.

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 8 6 9 – 8 8 5

877