According to European Association of Urology guidelines, in men with low-volume metastatic prostate cancer (mPCa; i.e., those with < 4 bone metastases), a combination of external beam radiation therapy (EBRT) and ADT is advised. Although this combined treatment has survival benefit, what is the potential impact on men’s quality of life?
A recent study out of the Netherlands aimed to better understand potential effects of combined treatment with EBRT plus ADT, versus ADT alone, on health-related quality of life (HRQoL) in men with primary bone mPCa.
To assess HRQoL, 432 men were randomly assigned to one of two treatment groups: 1) ADT plus EBRT to the prostate, or 2) ADT alone. Standardized, validated HRQoL questionnaires were administered at the start of treatment and again 3, 6, 12, and 24 months later.
Results:
1. At the 3-month mark, men in the radiotherapy group reported more diarrhea, bowel symptoms, and urinary symptoms.
2. At 6 months, men in the radiotherapy group reported better emotional functioning and less constipation versus men in the ADT only group.
3. At the 2-year follow-up, the only statistically significant difference between the two groups was in reports of bowel symptoms. At 2 years post-treatment, worsening of bowel symptoms was reported by 22% of patients in the radiotherapy group. General HRQoL did not decrease, however.
Overall, men who received combined treatment with EBRT plus ADT reported modest and temporary decreases in patient-reported HRQoL (urinary and bowel symptoms) that were largely resolved by 2 years post-treatment. As the authors note, given “the relatively mild and transient side effects of local radiotherapy in patients with metastatic disease, combined by a statistically significant improvement in overall survival, addition of EBRT to ADT is a well-balanced treatment option.” The authors also highlight the importance of discussing the benefits and risks of different treatment options with an oncology care provider.
To read the study abstract, see: https://www.sciencedirect.com/science/article/abs/pii/S0302283820306400?via%3Dihub
Boevé, L., Hulshof, M., Verhagen, P., Twisk, J., Witjes, W., de Vries, P., van Moorselaar, R., van Andel, G., & Vis, A. N. (2020). Patient-reported Quality of Life in Patients with Primary Metastatic Prostate Cancer Treated with Androgen Deprivation Therapy with and Without Concurrent Radiation Therapy to the Prostate in a Prospective Randomised Clinical Trial; Data from the HORRAD Trial. European urology, S0302-2838(20)30640-0. Advance online publication. https://doi.org/10.1016/j.eururo.2020.08.023