Session Item

To evaluate the persistence of patient-reported urinary symptoms after radiotherapy (RT) for prostate cancer (PCa) and quantify its impact on quality of life (QoL).

Longitudinal patient reported outcome from a prospective, multi-institutional study on PCa treated with radical RT (2010-2014) was analyzed. Information was collected at baseline (BL) and at regular follow-ups (FUPs) up to 5 years. Patients were included if assessments were present at BL and at least at 3 late FUPs (6 months and ongoing). Urinary symptoms were scored with the ICIQ-SF and IPSS questionnaires. These questionnaires are commonly analyzed as overall scores across multiple items. For this evaluation, 1 item from the ICIQ-SF (frequency, at a preliminary analysis mostly affecting QoL) and 7 items from the IPSS were analyzed individually. Score range was from 0 (no symptom) to 5. Persistence of symptoms was defined adapting a method previously developed and implemented for cervical cancer and named LAPERS. Symptoms were defined as “mild” or “moderate/severe” persistent if the median score over late FUPs was ≥1 or ≥2, respectively. BL condition was considered by requiring the median to be worse than the BL.

QoL was analyzed with the EORTC C30 questionnaire and linearly transformed into a continuous scale (0-100). Linear mixed-effects models (LMM) were applied to identify significant differences between men with and without moderate/severe persistent symptoms. Age, smoking status and diabetes were included as confounders. To quantify the impact of each symptom, the mean difference in QoL between the two groups was evaluated longitudinally over late FUPs.

The analysis included 420 patients. Proportions of patients with worsening moderate/severe symptoms are shown in Table 1. Nocturia was the most prevalent symptom since 90% of patients reported persistence (mild or moderate/severe) with or without worsening beyond BL.

Figure 1 shows the mean Global Health/QoL score at each FUP for patients with and without moderate/severe persistent urinary symptoms. Table 1 displays the mean difference in QoL aspects calculated between the groups. Role functioning and Global Health/QoL were the most impaired aspects. Incontinence, urgency and weak stream showed significant differences for all QoL domains, but with varying magnitude. Largest mean differences for Global Health/QoL were found for incontinence and urgency. Among all the symptoms, nocturia resulted in the least impairment, as significant differences were found only for physical functioning and Global Health/QoL.

This longitudinal analysis showed that urinary symptoms after RT for PCa occur with different persistence. The methodology allowed to identify men with persistent symptoms with and without worsening beyond BL condition and transient symptoms. Despite being the most prevalent, nocturia did not significantly impact long-term QoL. In contrary, incontinence and urgency were associated with much larger worsening in Global Health/QoL.