PURPOSE: The optimal timing of radiotherapy (RT) after radical prostatectomy (RP) remains controversial with unknown impact on health-related quality of life (HRQOL). We aimed to compare the influence of early RT (eRT) and deferred RT (dRT) on HRQOL. METHODS: 4511 patients were analysed. Inclusion criteria encompassed: ≥pT3, ISUP-grade ≥4, or positive surgical margin. A 1:4 propensity-score-matched-analysis of n=1599 patients was conducted [n=307: eRT, ≤6month after RP; n=1292: dRT, >6month after RP]. Primary endpoint was general HRQOL (based on EORTC QLQ-C30). Pearson correlation and binary logistic regression models were used to estimate the impact of timing of RT on HRQOL. Functional outcome was assessed using ICIQ-SF and IIEF-5 questionnaires. RESULTS: Median follow-up was 38 mo. At 12mo and 24mo follow-up, general HRQOL-scores were significantly higher for dRT (52.7 vs. 35.5; p=0.001; 45.8 vs. 37.3; p=0.026). ICIQ-SF scores were higher (8.5 vs. 6.1; p=0.001; 8.4 vs. 7.3; p=0.038), and IIEF-5 scores were lower (1.8 vs. 4.2; p=0.001; 2.2 vs. 4.4; p=0.005) for eRT at 12mo and 24mo. In multivariate-analysis, dRT was associated with superior general HRQOL at 12mo (OR 0.59, 95% CI 0.37-0.94, p=0.027) and 24mo, respectively (OR 0.64, 95% CI 0.39-0.99, p=0.043). A longer time-interval between RP and RT was associated with improved general HRQOL (OR 1.09, 95% CI 1.038-1.143; p <0.001). CONCLUSIONS: dRT yields improved short-term HRQOL compared to eRT. Since longer time-intervals between RP and RT predict better short-term HRQOL, our data provides further support for the concept of deferred RT at low PSA recurrence.
PURPOSE: The optimal timing of radiotherapy (RT) after radical prostatectomy (RP) remains controversial with unknown impact on health-related quality of life (HRQOL). We aimed to compare the influence of early RT (eRT) and deferred RT (dRT) on HRQOL. METHODS: 4511 patients were analysed. Inclusion criteria encompassed: ≥pT3, ISUP-grade ≥4, or positive surgical margin. A 1:4 propensity-score-matched-analysis of n=1599 patients was conducted [n=307: eRT, ≤6month after RP; n=1292: dRT, >6month after RP]. Primary endpoint was general HRQOL (based on EORTC QLQ-C30). Pearson correlation and binary logistic regression models were used to estimate the impact of timing of RT on HRQOL. Functional outcome was assessed using ICIQ-SF and IIEF-5 questionnaires. RESULTS: Median follow-up was 38 mo. At 12mo and 24mo follow-up, general HRQOL-scores were significantly higher for dRT (52.7 vs. 35.5; p=0.001; 45.8 vs. 37.3; p=0.026). ICIQ-SF scores were higher (8.5 vs. 6.1; p=0.001; 8.4 vs. 7.3; p=0.038), and IIEF-5 scores were lower (1.8 vs. 4.2; p=0.001; 2.2 vs. 4.4; p=0.005) for eRT at 12mo and 24mo. In multivariate-analysis, dRT was associated with superior general HRQOL at 12mo (OR 0.59, 95% CI 0.37-0.94, p=0.027) and 24mo, respectively (OR 0.64, 95% CI 0.39-0.99, p=0.043). A longer time-interval between RP and RT was associated with improved general HRQOL (OR 1.09, 95% CI 1.038-1.143; p <0.001). CONCLUSIONS: dRT yields improved short-term HRQOL compared to eRT. Since longer time-intervals between RP and RT predict better short-term HRQOL, our data provides further support for the concept of deferred RT at low PSA recurrence.