Does Curative Radiotherapy Impact Fatigue Onset in Prostate Cancer Patients? An Analysis of 1253 Patients

This study investigates the impact of radiotherapy (RT) on fatigue levels in prostate cancer (PC) patients, considering the significant physical and psychological impact of fatigue associated with cancer and its treatments.

PC patients undergoing a radical treatment from December 2002 to September 2022 were retrospectively evaluated. Fatigue was assessed using the Cancer Linear Analogue Scale (CLAS) across three dimensions: wellbeing (CLAS1), energy level (CLAS2), and daily activity performance (CLAS3), measured at baseline (T0), 1 month (T1), and 12 months (T2) post-RT. Changes in CLAS scores ≥ 2 points from T0 were deemed clinically significant for RT-induced fatigue.

The cohort consisted of 1253 patients, with a median age of 72 years (range 45-90). Approximately 30% of patients experienced moderate or high levels of fatigue at baseline. At T1, RT-related fatigue onset (decrease of CLAS1, 2, and 3 values) was observed in 10.8%, 14.3%, and 14.8% of patients, respectively. These figures slightly increased at T2 (12.7%, 18.8%, and 19.4%, respectively). Logistic regression identified hypofractionated RT, ADT, surgery, alcohol consumption, and higher-grade toxicities as predictors of worsened fatigue across various dimensions.

In this extensive cohort of PC patients, approximately 30% experienced moderate to severe fatigue before initiating RT, with less than 20% reporting new or exacerbated fatigue post-treatment. Factors including treatment-related toxicities, hypofractionation, alcohol use, and ADT were significant contributors to fatigue. These findings underscore the complexity of managing fatigue in PC, highlighting the influence of both treatment modalities and lifestyle factors.