Quality of Life After Postprostatectomy Radiotherapy: A TROG 08.03 RAVES Randomized Controlled Trial Substudy

There is continued uncertainty about whether the timing of radiotherapy (RT) after radical prostatectomy (RP) affects toxicity. This study assesses differences in patient-reported quality of life (QOL) for patients randomized to adjuvant RT (aRT) or salvage RT (sRT) after RP.

This is a planned secondary analysis of a randomized trial comparing aRT with sRT delivered if prostate-specific antigen increased to >0.2 ng/ml. QOL was measured using the EORTC (European Organization for Research and Treatment of Cancer) tools QLQ-C30 (Core Quality of Life Questionnaire) and QLQ-PR25 (Quality of Life Questionnaire - Prostate Cancer). The minimal clinically important change (MCIC) was a decline in QOL of >0.5 standard deviations from baseline.

Participants in the aRT arm (n = 166) had a higher proportion of patients reporting an MCIC in bowel symptoms at 1 to 5 yr after randomization compared to patients in the sRT arm who did not receive RT. At 5 yr, 16% of the patients in the aRT arm self-reported severe urinary incontinence compared to 2% in the no RT group (p = 0.01). When comparing patients in the aRT group to those in the sRT group who did receive RT, there were no statistically significant differences in urinary symptoms, bowel symptoms, or sexual functioning from 1 to 5 yr after RT. On regression analysis, the timing of sRT had no significant effect on QOL.

Patients receiving postprostatectomy RT reported a minor worsening in bowel symptoms and an increased risk of long-term urinary incontinence compared to patients who did not require RT. Overall, the timing of sRT has a limited association with patient-reported QOL.