Quality of life comparison for two prostate cancer treatments (proton therapy vs intensity modulated radiotherapy)

This article examined quality of life of patients treated with proton therapy compared with intensity modulated radiotherapy (IMRT) among patients with localized (confined) prostate cancer. 

This article deals with two treatment choices for localized prostate cancer. The first is proton therapy, a type of radiation that uses a beam of special particles called protons, instead of x-rays, to destroy cancer cells. The other is intensity modulated radiotherapy, a type of radiotherapy that uses advanced technology to plan a precise dose of radiation based on tumor size, shape and location. A computer-generated device then delivers hundreds of tiny beams of radiation that match the exact shape and size of the tumor, thus minimizing the damage to the healthy surrounding tissue. As these treatments have some influence on the patient’s urinary system, bowel function and sexual function, proton therapy and intensity modulated radiotherapy can affect one’s quality of life.

The purpose of this study was to compare patient-reported quality of life outcomes in proton therapy and intensity modulated radiotherapy using questionnaires. The questionnaires were comprised of questions regarding  urinary incontinence and irritation (such as painful urination), bowel function and sexual function. 

The study analyzed 1,482 patients with localized prostate cancer. 1,243 patients received proton therapy, and 204 underwent intensity modulated radiotherapy.  Questionnaires were collected at the beginning of the study and at six months, one year and two years after the treatment.

After two years, 177 patients from the intensity modulated radiotherapy group and 963 patients from the proton therapy group answered the questionnaires. The questionnaires highlighted that 11% of the intensity modulated radiotherapy patients had urinary problems (painful urination, weak stream, high frequency) versus 10% of the proton therapy group. Bowel problems (fecal incontinence, bloody stools, rectal pain) were reported in 11% of the intensity modulated radiotherapy group versus 7% of patients treated with proton therapy. Lastly, 33% of the intensity modulated radiotherapy group reported sexual dysfunction (poor/unreliable erections, difficulty with orgasm) compared with 35% of the proton therapy group.

3% of the intensity modulated radiotherapy patients suffered from bowel function urgency at the beginning of the study versus 15% after two years. 2% of the proton therapy patients suffered from bowel function urgency at the beginning of the study versus 7% after two years.

2% of the intensity modulated radiotherapy patients suffered from bowel function frequency at the beginning of the study versus 10% after two years. 1% of the proton therapy patients suffered from bowel function frequency at the beginning of the study versus 4% after two years.

There were no significant differences in the quality of life summary scores between the intensity modulated radiotherapy and proton therapy treatment groups during early follow-up of two years. However, more men who received intensity modulated radiotherapy reported moderate/big problems with rectal urgency and frequent bowel movements than those treated with proton therapy.

The study included an uneven number in between the groups. Not all patients answered the questionnaires which may have affected the results.