quality of life and late urinary morbidity in patients ... · patients submitted to prostatic...

Quality of Life and Late Urinary Morbidity in Patients Submitted to Prostatic Brachytherapy for

Localized Prostate Cancer Pedro Miguel Baltazar, João Pina, Raquel João, Hugo Pinheiro, Pedro Melo Rocha, Ana Meirinha, Miguel Almeida,

Natália Martins, José Paulo Patena Forte, Luís Campos Pinheiro

Urology Department, Centro Hospitalar Lisboa Central, Lisbon, Portugal

Head of Department: Prof. Dr. Luís Campos Pinheiro Hypothesis / Aims of Study:

Interpretation of Results / Concluding Message:

Study Design, Materials and Methods:

#499

Hypothesis: Brachytherapy is a valid treatment option for localized prostate cancer, frequently associated with low morbidity and good health related quality of life (HR-QoL) levels. The HR-QoL should be a health concern for doctors and patients in clinical decisions. There are few randomized studies relating the late urinary morbidity and HR-QoL in patients submitted to prostatic brachytherapy. Aims of Study: Study the late urinary morbidity and HR-QoL in patients submitted to prostatic brachytherapy; Assess the impact of pre-treatment IPSS score in the development of urinary morbidity; Assess and characterize late urinary morbidity and HR-QoL in patients submitted to prostatic brachytherapy; Assess the impact of urinary incontinence in HR-QoL and patient global satisfaction.

The presence of pre-treatment LUTS does not significantly influence the development of specific LUTS but has an impact in global urinary morbidity development in patients submitted to prostatic brachytherapy; The most prevalent symptom was nocturia; Incontinence appears to be a sub estimated problem and has an important impact in patients’ satisfaction and HR-QoL; The development of late urinary morbidity is independent of patients’ age at time of brachytherapy; Brachytherapy patients satisfaction and HR-QoL are high and it is a well-accepted treatment.

All patients submitted to prostatic brachytherapy between October 2003 and October 2013 in Hospital de São José (Lisbon) were asked to answer the EPIC, AUA-SS and ICIQ-SF questionnaires. The results were treated in function on pre-treatment IPSS score, patient’s age and time since the brachytherapy date.

Results:

Patients data: - 410 patients: - 11 died - 133 (32,4%) validly responded to questionnaires - Patients age: - Average: 71.62 years (SD: 6.48) - Median: 73 years - Age at attainment of Brachytherapy: - Average: 68.55 years (SD: 6.78) - Median: 69 years - 65 years: 42 patients, (31.58%) - ≥65 years: 91 patients, (68,42%) - Time since brachytherapy: - Average: 4.32 years, (SD: 2.50) - 1-2 years: 51 patients, (38.35%) - 3-4 years: 33 patients, (24.81%) - ≥5 years: 49 patients, (36.84%) - Pretreatment IPSS score: - IPSS score 0-7: 68 patients, (51.13%) - IPSS score ≥8: 65 patients, (48.87%)

Bibliography: Wei, J.T., et al (2002) “Comprehensive Comparison of Health-Related Quality of Life After Contemporary Therapies for Localized Prostate Cancer” Journal of Clinical Oncology 20, 2, 557-566; Hashine, K. et al (2011) “Health-related quality of life after radical retropubic prostatectomy and permanent prostate brachytherapy: a 3-year follow-up study” International Journal of Urology 18, 813-819; Haab, F. et al (2010) “Séquelles fonctionnelles de la prise en charge du cancer de prostate localisé “ Bulletin du Cancer 97, 12, 1537-1549; Miller, N.L. et al (2003) “Impact of a Novel Neoadjuvant and Adjuvant Hormone-Deprivation Approach on Quality of Life, Voiding Function, and Sexual Function after Prostate Brachytherapy” American Cancer Society 97, 5, 1203-1210; Krupski, T. et al (2000) “Quality-of-life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer” Urology 55, 5, 736-742; Miller, D.C. et al (2005) “Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation and brachytherapy” Journal of Clinical Oncology 23, 12, 2772-2780; Ferrer, M et al (2008) “Health-related quality of life 2 years after treatment with radical prostatectomy, prostate bradhytherapy, or external beam radiotherapy inpatients with clinically localized prostate cancer” International Journal Radiation Oncology Biology Physics 72,2, 421-432; Frank, S.J. et al (2007) “An assessment of quality life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer” American Urological Association 177, 2151-2156; Merrick, G.S. et al (2003) “Long-term urinary quality of life after permanent prostate brachytherapy” International Journal Radiation Oncology Biology Physics 56,2,454-461; Teishima, J. et al (2012) “Impact of pre-implant lower urinary tract symptoms on postoperative urinary morbidity after permanent prostate brachytherapy” International Journal of Urology 19, 1083-1089; Bradley, E.B., Bissonette, E.A., Theodorescu, D. (2004) “Determinants of long-term quality of life and voiding function of patients treated with radical prostatectomy or permanent brachytherapy for prostate cancer” BJU International 94, 1003-1009; Boettchaer, M. et al (2011) “Overactive bladder syndrome : an underestimated long-term problem after treatment of patients with localized prostate cancer?” BJU International 109, 1824-1830; Jacobs, B.L. et al (2011) “Changes in lower urinary tract symptoms after prostate brachytherapy” Journal of Contemporary Brachytherapy 3,3, 115-120; Borchers, H. et al (2004) “Permanent 125I-seed brachytherapy or radical prostatectomy : a prospective comparison considering oncological and quality of life results” BJU International 94, 805-811; No, D. et al (2013) “Evaluation of continence following 532 nm laser prostatectomy for patients previously treated with radiation therapy or brachytherapy” Lasers in Surgery and Medicine 45,358-361; Abrams, P. et al (2002) “The standardisation of terminology of lower urinary tract function: report from standardisation sub-committee of the International Continence Society” Neuroulogy and Urodynamics 21, 167-178; Abrams, P. et al (2003) “The standardisation of terminology of lower urinary tract function: report from standardisation sub-committee of the International Continence Society” Urology 61, 37-49; Donovan, J.L. et al (1996) “The ICS-“BPH “ Study: the psychometric validity and reliability of the ICSmale questionnaire” British Journal of Urology 77, 554-562; Mabjeesh, N.J. (2012) “Editorial comment to impact of pre-implant lower urinary tract symptoms on postoperative urinary morbidity after permanent prostate brachytherapy” The Japanese Urological Association 1090; Herr, H.W. (1994) “Quality of life of incontinent men after radical prostatectomy” The Journal of Urology 151, 652-654; Lee, W.R. et al (2001) “A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy” International Journal of Radiation Biology Physics 51,3,614-623; Heidenreich A. et al. “EAU Guidelines on Prostate Cancer 2013 “, European Association of Urology, 2013; McDougal et al. “Campbell-Wash Urology, 10th Edition Review”, 10th Edition, Elsevier-Saunders, Philadelphia, 2012.

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

0 0 0

1

4 4

7

10

5

3

0

2 2

0

1

0 0

1

0

1

0 0

Nu

mb

er

of

Pat

ien

ts

ICIQ-SF score (0-21)

ICIQ-SF score

Graphical number of patients with urinary incontinence distribution according to the ICIQ-SF score.(N=41; 30,83%).

88%

10%

2%

Small

Medium

Large

Amount of urine lost Total=n %

Small 36 87,8

Medium 4 9,8

Large 1 2,4

TOTAL 41 100

N.er Pads/day Total=n %

0 26 63,4

1 10 24,4

2 2 4,9

≥3 3 7,3

TOTAL 41 100

64%

24%

5% 7%

0

1

2

≥3

Interference in Daily Life Total=n %

Not a problem 6 14,6

Small problem 22 53,7

Medium problem 8 19,5

Large problem 5 12,2

TOTAL 41 100

Characterization of Urinary Incontinence and Its Relation with Patient Satisfaction:

Interference of Urinary Incontinence post-brachytherapy in Quality of Life:

Satisfaction Avaliation: Incontinent Patients vs Continent Patients

Are you satisfied with the results of

braqhytherapy?

Would you again opt for the same

treatment? Continent Incontinent Continent Incontinent

Yes +/- No Yes +/- No Yes Do not

know

No Yes Do not

know

No

81

(88,0%)

10

(10,9%)

1

(1.1%)

28

(68.3%)

7

(17.1%)

6

(14.6%)

89

(96,7%)

2

(2,2%)

1

(1.1%)

34

(82.9%)

3

(7.3%)

4

(9.8%)

(100%) (100%) (100%)

(100%)

Relationship between urinary incontinence and satisfaction of patients with brachytherapy:

ICIQ-SF score of patients with Urinary Incontinence:

Amount of urine lost due to urinary incontinence: Number of pads/day:

1-2 3-4 ≥5

Pretreatment IPSS 0-7 77,54 76,74 86,26

Pretreatment IPSS ≥8 72,69 73,23 64,63

Totality of patients 75,23 74,73 74,9

Variation of the Urinary Summary EPIC subscores in function of time since brachytherapy and in function of pre-brachytherapy IPSS score:

1-2 3-4 ≥5


Pretreatment IPSS≥8 78,08 80,63 71,56


1-2 3-4 ≥5




1-2 3-4 ≥5




1-2 3-4 ≥5




Variation of the Urinary Summary EPIC score (0-100) in function of time since brachytherapy and pre-brachytherapy IPSS score:

Variation of IPSS, O-IPSS (obstructive symptoms) and I-IPSS (irritative symptoms) Scores in Function of Time Since Brachytherapy:

Variation of "LUTS" in function of time since brachytherapy and in function of pre-brachytherapy IPSS score:

0 1-2 3-4 ≥5

IPSS (0-35) 9,2 10,7 8,7 9,8

0-IPSS (0-20) 4,7 5,7 4 4,9

I-IPSS (0-15) 4,4 5 4,7 5,1

Total = n 133 51 33 49

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,2 1 0,2 0,2 94

Pretreatment

IPSS 2-5

2,9 1,6 1 1,8 39

IPSS score 0,9 1,1 0,4 0,7 133

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,2 0,9 0,8 1,1 87

Pretreatment

IPSS 2-5

3,2 1,5 2,5 1,7 46

IPSS score 0,9 1,1 1,3 1,4 133

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,3 1,5 0,5 1,2 90

Pretreatment

IPSS 2-5

3,3 2,9 1,9 2,2 43

IPSS score 1,2 1,8 1 1,6 133

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,3 1,3 1 1 87

Pretreatment

IPSS 2-5

3,1 2,3 2,3 2,4 46

IPSS score 1,3 1,6 1,6 1,5 133

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,2 1,8 0,7 1,4 76

Pretreatment

IPSS 2-5

3,4 2,3 3 2,5 57

IPSS score 1,7 2 2 1,9 133

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,1 0,8 0,2 0,2 86

Pretreatment

IPSS 2-5

2,9 0,7 1,3 1,7 47

IPSS score 1 0,8 0,6 0,7 133

0 1-2 3-4 ≥5 Total=n

Pretreatment

IPSS 0-1

0,6 1,7 1,1 1,9 62

Pretreatment

IPSS 2-5

1,4 2,5 2,5 2,3 71

IPSS score 1 2,2 1,9 2,1 133

16%

59%

22%

3%

Incontinence vs QoL

Not a problemSmall problemMedium problemLarge problem

77,54 76,74

86,26

72,69 73,23

64,63

75,23 74,73 74,9

50

55

60

65

70

75

80

85

90

95

100

.1-2 .3-4 ≥5

Uri

nar

y Su

mm

ary

EP

IC s

core

Time (years)

Urinary Summary EPIC score

Pretreatment IPSS 0-7

Pretreatment IPSS ≥8

Totality of patients

89,42

81,77

88,71

78,08 80,63

71,56

84,02 81,12 79,71

50

60

70

80

90

100

.1-2 .3-4 ≥5

Uri

nar

y In

con

tin

ence

EP

IC s

core

Time (years)

Urinary Incontinence EPIC score




71,91 74,11

85,15

70,18 70,54

62,76

71,09 72,07 73,39

50

60

70

80

90

100

.1-2 .3-4 ≥5

Uri

nar

y Ir

rita

tive

/Ob

stru

ctiv

e EP

IC s

core

Time (years)

Urinary Irritative/obstructive EPIC score




88,35 84,58

89,13

78,71

86,69

75,82

83,76 85,79 82,14

50

60

70

80

90

100

.1-2 .3-4 ≥5 Uri

nar

y Fu

nct

ion

EP

IC s

core

Time (years)

Urinary Function EPIC score




69,81 71,13

84,21

68,39 63,62

56,7

69,13 66,84 69,77

50

60

70

80

90

100

.1-2 .3-4 ≥5

Uri

nar

y B

oth

er E

PIC

sco

re

Time (years)

Urinary Bother EPIC score




9,2

10,7

8,7 9,8

4,7 5,7

4 4,9 4,4

5 4,7 5,1

0

2

4

6

8

10

12

0 .1-2 .3-4 ≥5

IPSS

sco

re

Time (years)

Variation of IPSS, O-IPSS and I-PSS scores in function of time since brachytherapy

IPSS

O-IPSS

I-IPSS

0,2

1

0,2 0,2

2,9

1,6 1

1,8

0,9 1,1 0,4 0,7

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Intermittency (IPSS score)



IPSS score 0,2 0,9 0,8 1,1

3,2

1,5

2,5

1,7

0,9 1,1 1,3 1,4

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Urgency (IPSS score)



IPSS score

0,3

1,5

0,5 1,2

3,3 2,9

1,9 2,2

1,2 1,8

1 1,6

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Incomplete Emptying (IPSS score)



IPSS score 0,3

1,3 1 1

3,1 2,3 2,3 2,4

1,3 1,6 1,6 1,5

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Frequency (IPSS score)



IPSS score

0,2

1,8

0,7 1,4

3,4

2,3 3

2,5

1,7 2 2 1,9

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Weak Stream (IPSS score)



IPSS score0,1

0,8 0,2 0,2

2,9

0,7 1,3

1,7 1 0,8 0,6 0,7

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Straining (IPSS score)



IPSS score

0,6

1,7 1,1

1,9 1,4

2,5 2,5 2,3

1

2,2 1,9 2,1

0

1

2

3

4

0 .1-2 .3-4 ≥5

IPSS

sco

re (

0-5

)

Time (years)

Nocturia (IPSS score)



IPSS score

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