Mark Klein, MD
Treatment of prostate cancer presents significant challenges with respect to balancing efficacy and side effects of treatments. Thus, quality of life endpoints are included in studies of patients with prostate cancer to better understand and counsel patients with this heterogenous disease. In the 3 studies discussed here, functional or quality of life outcomes were included in the analyses.
In the first study, Hagens et al evaluated the effects of postoperative complications of robot-assisted radical prostatectomy on the health-related quality of life (HRQoL) as measured via surveys and assessment of functional outcomes. While no significant association between HRQoL at 6 months and complications postoperatively were identified, there was an association between functional outcomes and HRQoL at 6 months identified. Thus, future studies designed to identify more optimal patient selection or improved surgical techniques may benefit patients.
Studies have suggested that androgen deprivation therapy (ADT) may be associated with decreased cognitive function. However, other studies suggested that ADT via luteinizing hormone releasing hormone (LHRH) agonists or antagonists may actually have a protective effect against decreased cognitive function due to low gonadotropin exposure. Andela et al conducted a systematic review based on this hypothesis. Of the 31 studies included in the review, 16 demonstrated that ADT was not associated with decreased cognitive function, while 11 studies did support this association and 4 studies were inconclusive. Therefore, no definitive conclusions can be made based on this review, and further randomized studies are needed.
Radiation to the prostate may affect the rectum with sometimes significant effects. Hydrogel spacers injected between the prostate and rectum have been evaluated in patients with conventional radiation previously with evidence of benefit, but the benefits for patients undergoing stereotactic body radiotherapy (SBRT) are unknown. Ogita et al conducted a phase II single-arm study designed to evaluate the effects of a hydrogel spacer on gastrointestinal toxicity within 3 months of SBRT. Physician-assessed toxicity was not reduced, but patient reported toxicity was improved compared with historical controls. While this study does not support routine use in the setting of prostate SBRT, it does suggest that future larger randomized studies are worth consideration.