EURURO Vol. 72 No. 6

and, using the UCLA-PCI questionnaire, reported statistically

worse sexual function for patients in the RP arm. Namiki et al

[20]

also reported significantly better urinary function

scores for patients treated with BT. Another small study

[15]

reported that at 12 mo sexual function was impaired

significantly in patients after non-NSRP but not after NSRP

when compared with patients treated with BT. In the largest

prospective study

[19] ,

authors compared patients treated

with RP, BT, and cryotherapy. Statistical comparison for QoL

outcomes between RP and BT cannot be made (as

cryotherapy is not included in this review); nevertheless,

at 3 yr of follow-up, BT patients tended to have better sexual

and urinary scores.

Only two studies

[16,22]

compared QoL after BT and

EBRT using the EPIC questionnaire. Pinkawa et al

[22]

reported that BT was associated with statistically signifi-

cantly higher urinary toxicity at 16 mo. Evans et al

[16]

reported similar results; however, SBRT was associated

with lower bowel toxicity than BT at 2 yr.

3.5.

Discussion

3.5.1.

Principal findings

The current review synthesises the existing evidence

regarding cancer-specific QoL outcomes of competitive

treatments for clinically localised PCa. QoL is an important

end point in PCa treatment, and recently the COMPACTERS

study group, which developed a core outcome set for trials

of effectiveness, identified QoL as an outcome which should

be measured in all clinical trials of localised PCa

[31] .

Out-

comes were measured by PROMs, and the three most used

studies among the those included were EPIC, UCLA-PCI, and

EORTC QLQ-C30.

The ProtecT trial

[12]

provides level 1 evidence for the

different effects of PCa treatments on disease-specific QoL

No difference was found among treatment modalities in

global QoL at 5 yr. However, surgery had a negative effect on

urinary continence and sexual function, EBRT was associat-

ed with a negative effect in bowel function which was more

intense in the 1st year after treatment, while active

monitoring had the lowest impact on disease-specific QoL

at 6 yr. PCOS 5-yr results

[26]

confirm that men who

underwent RP had a higher prevalence of urinary inconti-

nence and erectile dysfunction, while those treated with

EBRT had a higher prevalence of bowel dysfunction. Results

from ProtecT trial are also comparable with the findings of

the Prostate Cancer Intervention Versus Observation Trial

[32]

as authors reported that at 2 yr, urinary incontinence

and erectile dysfunction were significantly more common

among men who were assigned to RP when compared with

men managed with observation.

Most other observational studies provide similar, con-

sistent, intermediate-term results for RP and EBRT. Howev-

er, in a recently published study

[30]

, investigators reported

that although EBRT was associated with a negative effect in

bowel function, the difference in bowel domain score was

below the threshold for clinical significance 12 mo after

treatment. As 81% of patients in the EBRT arm of the study

received IMRT, these data suggest that the risk of side

Table 4 (

Continued

)

Author (year)

(longest follow-up time)

Questionnaire used

Intervention

at baseline

Reported results

a (la

test follow-up data of each study)

Studies that report change in QoL score within groups

Sanda

(2008)

[27]

4 mo)

Radical

prostatectomy

603

Urinary Incontinence

Urinary obstructive–

irritative

Bowel function Sexual function

Hormonal function

EPIC

EBRT

292

Urinary Incontinence

Urinary obstructive–

irritative

Bowel function Sexual function

(only for EBRT

plus NHT)

Hormonal function

(only for EBRT

plus NHT)

Brachytherapy

306

Urinary Incontinence

Urinary obstructive–

irritative

Bowel function Sexual function

Hormonal function

EBRT = external beam radiotherapy; EPIC = Expanded Prostate Cancer Index Composite; IMRT = intensity-modulated radiotherapy; N = number of patients; NHT = neoadjuvant hormone therapy; NSRP = nerve-sparing

radical prostatectomy; PCOS = Prostate Cancer Outcomes Study; QoL = quality of life; RP = radical prostatectomy; SBRT = stereotactic body radiotherapy; UCLA-PCI = University of California, Los Angeles Prostate Cancer

Index.

For studies comparing interventions, the red colour indicates statistically significant deterioration between a treatment group and the reference group of the study. For studies that report changes in QoL within groups, it

indicates statistically significant deterioration of QoL score from baseline. Orange colour also indicates statistically significant deterioration; however, the difference between groups or within groups does not exceed the

minimally important difference for clinical significance, as defined by authors. This is applicable only for studies reporting minimally important difference for clinical significance. For studies comparing interventions green

colour indicates statistically significant improvement between a treatment group and the reference group of the study. For studies that report changes in QoL within groups, it indicates statistically significant improvement

of QoL score from baseline. No colour indicates no statistically significant difference (for studies comparing interventions, it corresponds to the intervention used as reference and to those that do not show significant

difference with this reference; for studies that report changes in QoL within groups, it shows intervention for which the QoL did not show significant change over time).

Malcolm et al’s study

[19]

not presented in the table as authors report

values for between-group comparisons taking into consideration the cryotherapy arm, which we are not including in our review. Symon et al’s

study

[29]

also not presented in the table as authors do not report differences in disease-specific QoL scores among different treatments.

In EPIC questionnaire, urinary function items and bother items are combined in the urinary incontinence subscale and the urinary irritation/obstruction subscale.

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

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