Late Effects to the Rectum and Anus in Prostate Cancer Patients Randomized to Hormonal Therapy Versus Hormonal Therapy Plus Radiotherapy

Abstract

AIM: The aims of this study were to evaluate patient reported outcomes, physician assessed toxicity and physiological measurements in patients randomized to hormonal treatment versus hormonal treatment plus radiotherapy for locally advanced prostate cancer. METHODS: The Scandinavian Prostate Cancer Group SPCG-7/SFUO-3 study included 880 patients from 47 centres in Scandinavia. One hundred and sixty-one patients randomized at St. Olavs Hospital were approached for inclusion in the study. The patients were evaluated by two patient reported symptom scores (EORTC QLQ-C30 and QUFW94), physician assessed toxicity score (LENT/SOMA) and physiological measurements (anorectal manometry and endoanal ultrasound). RESULTS: Five years after cancer treatment, there were significantly higher symptom burdens in several QUFW94 single items in the group of patients treated by radiotherapy. Mean LENT/SOMA score was 0.15 for patients with hormonal therapy plus radiotherapy, compared to 0.03 for patients treated by hormonal therapy alone (p<0.001). Patients treated by radiotherapy had reduced rectal compliance compared to patients treated by hormonal therapy alone (43 mL vs 64 mL, p<0.001). CONCLUSION: This trial provides evidence that addition of radiotherapy to hormonal therapy for locally advanced prostate cancer implies deterioration of anorectal function.