Patient-reported functional outcomes after hypofractionated radiation for prostate cancer

Abstract

Purpose or Objective To determine patient-reported functional outcomes (PROs) in men with prostate cancer (PCa) undergoing moderately hypofractionated (H-RT) or conventionally fractionated radiotherapy (C-RT) in a national cohort study. Material and Methods All men diagnosed with PCa between April 2014 and September 2016 in the English National Health Service undergoing C-RT or H-RT were identified in the National Prostate Cancer Audit and mailed a questionnaire at least 18 months after diagnosis. Differences in patient-reported urinary, bowel, sexual, and hormonal function (EPIC-26 domain scores on a 0-100 scale) and health-related quality of life (EQ5D5L on a 0-1 scale) were estimated using linear regression with adjustment for patient, tumour and treatment-related factors in addition to gastrointestinal (GI) and genitourinary (GU) baseline function with higher scores representing better outcomes. Results Of the 17,058 men in the cohort, 77% responded: 8,432 men had C-RT (64.2%) and 4,699 H-RT (35.8%). Men in the H-RT group were older (≥70 years: 67.5% versus 60.9%), fewer men had locally advanced disease (56.5% versus 71.3%), were less likely to receive ADT (79.5% versus 87.8%) and slightly more men had pre-treatment GU procedures (24.2% versus 21.2%). H-RT was associated with small increases in adjusted mean EPIC-26 sexual (3.3 points; 95% CI 2.1-4.5, p<0.001) and hormonal function scores (3.2 points; CI 1.8-4.6, p<0.001). These differences failed to meet established thresholds for a clinically meaningful change. There were no statistically significant differences in urinary or bowel function and quality of life. Conclusion This is the first national cohort study comparing functional outcomes after H-RT and C-RT reported by patients. These ‘real-world’ results further support the use of H-RT as the standard for radiotherapy in men with non-metastatic PCa.