An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer

Purpose: Monotherapy with radical prostatectomy, high dose external beam radiotherapy or a I-125 implant is reported to produce equivalent outcomes. We assessed the health related quality of life associated with these 3 treatment approaches. Materials and Methods: Extended Prostate Index Composite surveys were mailed to all 960 patients treated with a I-125 implant, high dose external beam radiotherapy or radical prostatectomy with or without hormonal therapy at our institution from 1998 to 2000. A total of 625 patients (65%) completed the surveys. Nerve sparing radical prostatectomy was performed when appropriate. The I-125 implant consisted of 145 Gy and high dose external beam radiotherapy consisted of 78 Gy. For urinary, rectal and sexual domains mean scores were calculated, compared by treatment modality and compared to normative values. Results: A total of 234 patients with radical prostatectomy, 135 with external beam radiotherapy and 74 with a I-125 implant were treated with a monotherapy approach. Median age was 61 years in the radical prostatectomy group, 68 years in the high dose external beam radiotherapy group and 64 years in the I-125 implant group (p < 0.001). Of the patients 97% or greater had cT1-2 disease and Gleason score 7 or greater. Median time from treatment was 4.0 years for radical prostatectomy, 4.7 years for high dose external beam radiotherapy and 3.5 years for I-125 implantation. Radiation caused significantly worse bowel bother and bowel function than radical prostatectomy (p <= 0.018). Patients with high dose external beam radiotherapy had significantly better urinary function than patients with radical prostatectomy (p < 0.001). While patients with radical prostatectomy had significantly worse urinary incontinence than those with a I-125 implant or high dose external beam radiotherapy (p < 0.0001), patients with a I-125 implant had more urinary irritation than those with high dose external beam radiotherapy and radical prostatectomy (p < 0.01 and < 0.0001, respectively). Patients with a I-125 implant had significantly better sexual function than those with high dose external beam radiotherapy and radical prostatectomy (p = 0.01 and 0.0003, respectively). Conclusions: Of patients with prostate cancer treated with a monotherapy approach we noted better urinary continence in those who underwent radiation based therapies, and better bowel function and less urinary irritation in those who underwent surgery. Sexual function was impaired across all monotherapies but higher scores were seen in men who selected brachytherapy.