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Self-assessed sexual function after pelvic irradiation for prostate carcinoma: Comparison with an age-matched control group
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
1996 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 78, no 5, 1066-1078 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND. Treatment of localized prostate carcinoma is often accompanied by disturbances in sexual function. The patient's own opinion and experience with these problems can be of great importance for his quality of life. In men older than 50 years, disturbances in sexual function are common. Treatment such as radiotherapy (RT), which can induce sexual dysfunction, should be evaluated in relation to the problems in an age-matched population without prostate carcinoma. METHODS. Sexual function was evaluated with a self-assessment questionnaire using linear-analogue scales. The questionnaire was sent to 199 patients with prostate carcinoma, median age 71 years (range, 51-86 years), who had received pelvic RT with curative intent and to 200 age-matched men in northern Sweden. Mean follow-up time after RT was 48 months (range, 24-56 months). RESULTS. The response rate was high: 141 (71%) and 181 (91%) in the control and patient groups, respectively. Field reduction and treatment pause during RT was not associated with decreased problems in the patient groups. A failure to achieve erection was indicated in 12% of the control subjects, 56% of the patients who had received (RT only) and 87% of the RT + castration (RT + A) patients. In general, patients < 70 years treated with RT + A indicated more sexual problems than the RT only patients < 70 years. There was a strong negative correlation between age and sexual problems in the RT 9 A < 70 years group. However, in patients < 70 years, sexual activity after RT only, was not significantly different from the age-matched control population. CONCLUSIONS. Patients with prostate carcinoma treated with RT only indicated higher levels of sexual dysfunction than age-matched controls. This was most obvious in patients younger than 70 years, although their sexual activity was comparable to age-matched controls. The addition of castration to RT tended to increase sexual problems, especially in patients < 70 years. In men between 70 and 74 years, the maintenance of sexual function seems to be very susceptible to disturbances. For patients older than 74 years, decreased sexual function was not perceived as such a significant problem, despite abolished desire and erection. (C) 1996 American Cancer Society.

Place, publisher, year, edition, pages
John Wiley & Sons, 1996. Vol. 78, no 5, 1066-1078 p.
Keyword [en]
prostate carcinoma, irradiation, complications, sexual function, self-assessment, questionnaire, control group
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-66904DOI: 10.1002/(SICI)1097-0142(19960901)78:5<1066::AID-CNCR17>3.0.CO;2-0ISI: A1996VD62400017OAI: oai:DiVA.org:umu-66904DiVA: diva2:610497
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-06 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Quality of life and side effects in patients with localized prostate cancer: evaluation with self-assessment questionnaires
Open this publication in new window or tab >>Quality of life and side effects in patients with localized prostate cancer: evaluation with self-assessment questionnaires
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Localized prostate cancer (LPC) is predominantly a tumor among older men, and few patients will get symptoms from the disease. All methods to treat LPC with a curative intent have different types and degrees of side effects. It is therefore very important to evaluate the side effects thoroughly to make sure that treatment complications will not decrease the quality of life more than the disease would have done. In search for new and better treatments, complications has to be registered and evaluated in relation to quality of life (QOL) for the patients. Few validated self-assessment questionnaires for evaluation of external radiotherapy (EBRT) induced side effects has yet been developed. The present project focus on the development of the PC-specific questionnaire, QUFW94, and evaluation of symptoms in patients treated with EBRT and un-treated (watchful waiting) patients with a LPC.

In the newly developed LPC-specific questionnaire a reliability and responsiveness test was performed. Both the inter-rater test and the test-retest show high correlation coefficients (ICC), above 0.60 for all scales. The internal reliability exceeded the lower acceptable limit (Cronbach a >0.70). The questionnaire was proven to be valid for the evaluations of EBRT side effects in LPC patients.

Late side effects were evaluated 4 years after treatment in 181 LPC patients, treated with conventional large field EBRT, and compared with 141 age-matched PC disease free men. The most prominent urinary side effects were urgency and leakage which were doubled in the patient group. A ten fold increase was seen in comparison to controls at the most prominent intestinal problems, blood, mucus and leakage. The results support the use 3-D conformai therapy to decrease irradiation dose to the rectum and the bladder and thereby decreased side effects. A prospective additional evaluation 8 years after EBRT did not show any changes in urinary problems between 4 and 8-yr follow-up in the patients or the controls.

EBRT of LPC is also accompanied by disturbances in sexual function. These problems were therefore evaluated, 4 years after EBRT, in relation to the function in PC free men. Patients treated with EBRT indicated higher levels of sexual dysfunction than age-matched controls. No erection was reported from 12% of the control subjects, 56% of the patients who had only received radiotherapy (RT) and 87% of the RT+castration (RT+A) patients. The extended evaluation 8 years after EBRT show similar sexual function in all groups.

QOL and late side effects/symptoms were evaluated in the first and only randomized trial between RT and deferred treatment (DT) and compared to age-matched controls. QOL was evaluated with the general QOL formula, EORTC's QLQ-C30 (+3), and LPC specific side effects with QUFW94 in 108 randomized patients with LPC 3 years after diagnosis. Social functioning was the only QOL scale where a significant difference was found between the two patient groups and in comparison with the control group. Multivariate regression analysis showed that hematuria, incontinence, mucus, and planning of the daily activities due to intestinal problems caused this decrease in QOL in the RT group. In conclusion, the LPC specific QUFW94 questionnaire was proven to be valid for evaluation of side effects and showed increased intestinal problems in the patients treated with conventional large field EBRT in comparison to untreated LPC patients. No difference in urinary and intestinal late side effects or sexual function was seen between a 4 year vs. 8 year follow-up.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2000. 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 701
Keyword
prostate cancer, radiotherapy, complications, self assessment, questionnaires, validation, deferred treatment, quality of life
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-66906 (URN)91-7191-924-4 (ISBN)
Public defence
2000-11-24, Norrlands universitetssjukhus, byggnad 7, sal 244, Umeå universitet, Umeå, 10:00
Opponent
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-06 Last updated: 2013-03-11Bibliographically approved

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Fransson, PerWidmark, Anders

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