Quality of Life in Prostate Cancer Patients after External Beam Radiotherapy, Docetaxel Chemotherapy and Combined Therapy: And the Impact of Comorbidity and Performance Status on the Survival after External Beam Radiotherapy

Miikka Lehtonen

Research output: Book/ReportDoctoral thesisCollection of Articles

Abstract

The evaluation of quality of life effects is a part of the process that new pharmaceuticals and medical devices should undergo before becoming part of clinical practice in prostate cancer treatment. In addition to the evaluation of quality- of-life effects, when choosing the optimal treatment modality for a patient, international guidelines also suggest assessment of the patient’s life expectancy, which is in turn affected by the patient’s comorbidity and performance status.

This dissertation addresses the effects of curative-intent external beam radiotherapy for prostate cancer on patient quality of life when given with docetaxel (Study III) or without it (Study II). The quality-of-life effects of different docetaxel regimens in metastatic, castration-resistant prostate cancer were studied in different docetaxel regimens (Study IV). The impact of comorbidity and performance status on survival outcomes was evaluated in patients treated with external beam radiotherapy given for local prostate cancer (Study I).

Study I was a retrospective study that consisted of patients of Tampere University Hospital treated with external beam radiotherapy between 2008 and 2013. Comorbidity was assessed by the Charlson Comorbidity Index (CCI) and performance status was assessed by the Zubrod Performance Status. The study showed, that high CCI scores (≥4 points) and Zubrod Performance Status values of one point or more are linked to higher all-cause mortality. Additionally, the general survival outcomes at Tampere University Hospital were determined.

Study II consisted of the participants of the ESKO-trial, whose quality-of-life results were compared with the general, age-standardised Finnish male population. In the ESKO trial, 73 patients with local, intermediate-risk prostate cancer were given external beam radiotherapy without androgen-deprivation therapy. Data collection was conducted prospectively, and the study was not randomized. Radiotherapy was either conventionally fractionated, moderately hypofractionated or stereotactic body radiation therapy. The quality-of-life results of ESKO participants were also compared to their pretreatment values. The results showed that the quality of life after treatment was similar to that of the general population and the pretreatment values. However, some aspects such as sexual activity were worse after treatment and this particular facet remained poorer for a long period of time.

Study III consisted of patients who participated to SPCG-13 trial. In this prospective, randomized trial, 376 patients with local, intermediate- or high-risk prostate cancer were given radiation therapy (total dose of at least 74 grays) and androgen-deprivation therapy with LHRH-analogue for nine months. Furthermore, the intervention group was given 75 milligrams per square metre (mg/m2) docetaxel every three weeks for six treatment cycles. The study reported decreased quality of life in the intervention arm in total quality-of-life score and in physical and functional well-being scores at six months, but the quality-of-life results in both arms were similar at one year and at four years.

Study IV investigated patients with metastatic, castration-resistant prostate cancer in the first-line treatment. It included participants from the prospective, randomized trial PROSTY. In the PROSTY trial, 361 participants were given docetaxel at a dosage of either 50 mg/m2 every two weeks or docetaxel 75 mg/m2 every three weeks. Additionally all patients were given prednisolone 10 milligrams a day. Neither treatment was superior in terms of quality of life. No large differences were found in quality-of-life subdomains, but the treatment given every two weeks may be superior to some extent in some aspects, such as emotional well-being.

In conclusion, the survival outcomes of external beam radiotherapy for local prostate cancer in Tampere University Hospital were good and equivalent to those in other high-income countries. The quality-of-life results were mainly comparable with those of the general population and the patient’s pretreatment level. Conversely, docetaxel seems to affect quality of life negatively in patients with a local prostate cancer. In patients with a local disease, the need for such treatment should be carefully examined individually. In patients with metastatic, castration-resistant cancer, it is also important to find optimal dosing for patients to minimize harm and improve treatment outcomes.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic)978-952-03-2928-0
Publication statusPublished - 2023
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
Volume812
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028

Fingerprint

Dive into the research topics of 'Quality of Life in Prostate Cancer Patients after External Beam Radiotherapy, Docetaxel Chemotherapy and Combined Therapy: And the Impact of Comorbidity and Performance Status on the Survival after External Beam Radiotherapy'. Together they form a unique fingerprint.

Cite this