PMID- 34154899 OWN - NLM STAT- MEDLINE DCOM- 20220210 LR - 20230217 IS - 1873-2496 (Electronic) IS - 1078-1439 (Print) IS - 1078-1439 (Linking) VI - 40 IP - 2 DP - 2022 Feb TI - Association between pelvic nodal radiotherapy and patient-reported functional outcomes through 5 years among men undergoing external-beam radiotherapy for prostate cancer: An assessment of the comparative effectiveness analysis of surgery and radiation (CEASAR) cohort. PG - 56.e1-56.e8 LID - S1078-1439(21)00191-5 [pii] LID - 10.1016/j.urolonc.2021.04.035 [doi] AB - BACKGROUND: The role of pelvic irradiation in men receiving external beam radiotherapy (EBRT) for prostate cancer is unclear, in part due to a lack of data on patient-reported outcomes. We sought to compare functional outcomes for men receiving prostate and pelvic versus prostate-only radiotherapy, longitudinally over 5 years. MATERIALS AND METHODS: We performed a population-based, prospective cohort study of men with clinically-localized prostate cancer undergoing EBRT. We examined the effect of prostate and pelvic (n = 102) versus prostate-only (n = 485) radiotherapy on patient-reported disease-specific (using the Expanded Prostate Cancer Index Composite[EPIC]-26) and general health-related (using the SF-36) function, over 5 years. Regression models were adjusted for outcome-specific baseline function, clinicopathologic characteristics, and androgen deprivation therapy (ADT). RESULTS: 587 men (median [quartiles] age 69 [64-73] years) met inclusion criteria and completed >/=1 post-treatment survey. More men treated with prostate and pelvic radiotherapy had high-risk disease (58% vs. 18%, P < 0.01) and received ADT (75% vs. 41%, P < 0.01). These men reported worse sexual (6 months-5 years), hormonal (at 6 months), and physical (6 months-5 years) function. Accounting for baseline function, patient and tumor characteristics, and use of ADT, pelvic irradiation was not associated with statistically or clinically significant differences in bowel function, urinary incontinence, irritative voiding symptoms or sexual function through 5-years (all P > 0.05). Marginally clinically important differences were noted in hormonal function at 3-years (adjusted mean difference 4.7, 95% confidence interval [1.2-8.3]; minimally clinically important difference (MCID) 4 to 6) and 5-years (4.2, [0.4-8.0]) following treatment. After adjustment, there was a transient statistically significant, but not clinically important, difference in emotional well-being at 6 months (3.0, [0.19-5.8]; MCID 6) that resolved by 1 year and no differences in physical functioning or energy and fatigue. CONCLUSION: This prospective, population-based cohort study of men with localized prostate cancer treated with EBRT, showed no clinically important differences in disease-specific or general health-related quality of life with the addition of pelvic irradiation to prostate radiotherapy, supporting the use of pelvic radiotherapy when it may be of clinical benefit, such as men with increased risk of nodal involvement. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Wallis, Christopher J D AU - Wallis CJD AD - Department of Urology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: wallis.cjd@gmail.com. FAU - Huang, Li-Ching AU - Huang LC AD - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. FAU - Zhao, Zhiguo AU - Zhao Z AD - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. FAU - Penson, David F AU - Penson DF AD - Department of Urology, Vanderbilt University Medical Center, Nashville, TN. FAU - Koyama, Tatsuki AU - Koyama T AD - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. FAU - Conwill, Ralph AU - Conwill R AD - Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN. FAU - Tallman, Jacob E AU - Tallman JE AD - Department of Urology, Vanderbilt University Medical Center, Nashville, TN. FAU - Goodman, Michael AU - Goodman M AD - Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA. FAU - Hamilton, Ann S AU - Hamilton AS AD - Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA. FAU - Wu, Xiao-Cheng AU - Wu XC AD - Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA. FAU - Paddock, Lisa E AU - Paddock LE AD - Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ. FAU - Stroup, Antoinette AU - Stroup A AD - Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ. FAU - Cooperberg, Matthew R AU - Cooperberg MR AD - Department of Urology, University of California, Berkeley, CA. FAU - Hashibe, Mia AU - Hashibe M AD - Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT. FAU - O'Neil, Brock B AU - O'Neil BB AD - Department of Urology, University of Utah Health, Salt Lake City, UT. FAU - Kaplan, Sherrie H AU - Kaplan SH AD - Department of Medicine, University of California Irvine, Irvine, CA. FAU - Greenfield, Sheldon AU - Greenfield S AD - Department of Medicine, University of California Irvine, Irvine, CA. FAU - Barocas, Daniel A AU - Barocas DA AD - Department of Urology, Vanderbilt University Medical Center, Nashville, TN. FAU - Hoffman, Karen E AU - Hoffman KE AD - Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston, TX. LA - eng GR - R01 CA230352/CA/NCI NIH HHS/United States GR - R01 HS019356/HS/AHRQ HHS/United States GR - R01 HS022640/HS/AHRQ HHS/United States GR - T32 CA106183/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. DEP - 20210619 PL - United States TA - Urol Oncol JT - Urologic oncology JID - 9805460 SB - IM MH - Aged MH - Cohort Studies MH - Humans MH - Male MH - Middle Aged MH - *Patient Reported Outcome Measures MH - Prospective Studies MH - Prostatic Neoplasms/*radiotherapy/*surgery MH - Quality of Life/*psychology PMC - PMC9933913 MID - NIHMS1760020 OTO - NOTNLM OT - Cohort studies OT - Patient reported outcome measures OT - Prospective studies OT - Prostatic neoplasms OT - Survey and questionnaires COIS- CONFLICT OF INTEREST: None EDAT- 2021/06/23 06:00 MHDA- 2022/02/11 06:00 PMCR- 2023/02/16 CRDT- 2021/06/22 05:49 PHST- 2021/02/26 00:00 [received] PHST- 2021/04/12 00:00 [revised] PHST- 2021/04/23 00:00 [accepted] PHST- 2021/06/23 06:00 [pubmed] PHST- 2022/02/11 06:00 [medline] PHST- 2021/06/22 05:49 [entrez] PHST- 2023/02/16 00:00 [pmc-release] AID - S1078-1439(21)00191-5 [pii] AID - 10.1016/j.urolonc.2021.04.035 [doi] PST - ppublish SO - Urol Oncol. 2022 Feb;40(2):56.e1-56.e8. doi: 10.1016/j.urolonc.2021.04.035. Epub 2021 Jun 19.