Pelvic symptoms after radiotherapy in prostate cancer: a cross-sectional study

Despite the technical and scientific progress that improved therapeutic resources available in Oncology, adverse effects of treatment can be prominent, impacting the quality of life (QoL).

Objective:

This research aims to determine the prevalence of post-radiotherapy pelvic symptoms in prostate cancer (PC) and its impact on QoL.

Methods:

We assessed three groups of patients at different stages during radiotherapy (RT): Pre-RT, evaluated before of RT; Post-RT#1, evaluated between six months and one year post-RT; Post-RT#2, evaluated between two and a half and four years post-RT. The presence of urinary incontinence (UI), its characteristics and impact on daily living activities (DLA) were evaluated by ICIQ-SF questionnaire. WHOQOL-BREF questionnaire was used to assess QoL. Student t test was used, considering significant p < 0.05.

Results:

Thirty-three men were assessed (pre-RT, n = 12; Post-RT#1, n = 10; Post-RT#2, n = 11). The prevalence of lower urinary tract symptoms (LUTS) was highest in Post-RT#1 group. Post-RT#2 group had the highest prevalence of post-RT UI. In QoL, Pre-RT and Post-RT#2 groups experiencing the greatest impact on physical, environmental and overall QoL.

Conclusion:

Acute effect of RT is characterized by a high prevalence of LUTS. Post-RT#2 group experienced the most adverse effects on DLA due to a higher prevalence of post-RT UI.

Keywords:
Prostatic Cancer; Radiotherapy; Urinary Incontinence; Quality of Life

	Pre-RT group	Post-RT #1 group	Post-RT #2 group
	(n = 12)	(n = 10)	(n = 11)
Age (years)	71.4 ± 1.9	67.5 ± 3.1	70.5 ± 2.2
	(61-81 years)	(51-79 years)	(59-81 years)
*BMI (kg/m* ² )	27.9 ± 1.7	29.8 ± 1.8	26.3 ± 1.3
*Scholarity*
Illiterate	4 (33,3)	1 (10)	2 (18,2)
Primary school	7 (58,3)	7 (70)	7 (63,6)
Middle school	1 (8,3)	1 (10)	0 (0)
Technical school	0 (0)	1 (10)	0 (0)
Higher education	0 (0)	0 (0)	2 (18,2)
*Marital status*
Single	0 (0)	1 (10)	0 (0)
Married	9 (75)	9 (90)	6 (54,5)
Divorced	2 (16,7)	0 (0)	4 (36,4)
Widower	1 (8,3)	0 (0)	1 (9,1)
*Colour*
White	9 (75)	8 (80)	8 (72,7)
Black	3 (25)	2 (20)	3 (27,3)
Yellow	0 (0)	0 (0)	0 (0)
*Comorbidities*
Hypertension	8 (66,7)	6 (60)	5 (45,5)
Diabetes mellitus	2 (16,7)	1 (10)	2 (18,2)
*Health habits*
Sedentary lifestyle	10 (83,3)	5 (50)	11 (100)
Alcoholism	1 (8,3)	3 (30)	6 (54,5)
Smoking	3 (25)	1 ( 10)	2 (18,2)

	Pre-RT group	Post-RT #1 group	Post-RT #2 group
	(n = 12)	(n = 10)	(n = 11)
PSA (ng/mL)	23.8 ± 4.0	10.1 ± 2.2	23.7 ± 8.0
Risk
Low	1 (8.3)	6 (60)	4 (36.4)
Intermediate	2 (16.7)	2 (20)	3 (27.3)
High	9 (75)	2 (20)	4 (36.4)
*Prostatectomy*	1 (8.3)	4 (40)	3 (27.3)
*TURP*	2 (16.7)	3 (30)	0 (0)
*Hormone therapy*	11 (91.7)	3 (30)	7 (63.6)
*Radiotherapy*
Post-RT time (days)	-	244.1 ± 12.9 (157-287)	1129.9 ± 37.6 (929-1389)
Post-RT time (month)	-	8.0	37.2
Dose (Gy)	-	71.6 ± 0.8	74.6 ± 1.2

Pelvic symptoms	Pre-RT group		Post-RT #1 group		Post-RT #2 group
Pelvic symptoms	(n = 12)		(n = 10)		(n = 11)
	Pre-RT	Post-RT	Pre-RT	Post-RT	Pre-RT	Post-RT
Urinary complaints
Asymptomatic	0 (0)	-	2 (20)	1 (10)	4 (36.4)	4 (36.4)
Obstructive	1 (8.3)	-	5 (50)	1 (10)	3 (27.3)	0 (0)
Irritative	3 (25)	-	0 (0)	3 (30)	0 (0)	5 (54.5)
Nocturia < 3x/night	4 (33.3)	-	0 (0)	1 (10)	0 (0)	1 (9.1)
Nocturia ≥ 3x/night	6 (50)	-	1 (10)	7 (70)	1 (9.1)	4 (36.4)
UI	5 (41.7)	-	0 (0)	2 (20)	1 (9.1)	5 (45.5)
*Anorectal complaints*
Anal pain	0 (0)	-	1 (10)	0 (0)	0 (0)	0 (0)
Constipation	0 (0)	-	0 (0)	0 (0)	0 (0)	1 (9.1)
Proctitis	0 (0)	-	0 (0)	0 (0)	0 (0)	1 (9.1)
AI and fecal urgency	0 (0)	-	0 (0)	1 (0)	0 (0)	0 (0)
*Sexual complaints*
ED	12 (100)	-	6 (60)	4 (40)	6 (54.5)	4 (36.4)

ICIQ-SF	Pre-RT group	Post-RT #1 group	Post-RT #2 group
ICIQ-SF	(n = 12)	(n = 10)	(n = 11)
Frequency (Question 3)
Never	7 (58.3)	8 (80)	6 (54.5)
≥ once per week	1 (8.3)	0 (0)	1 (9.1)
2-3 times per week	1 (8.3)	0 (0)	1 (9.1)
once per day	0 (0)	1 (10)	1 (9.1)
Several times per day	3 (25)	1 (10)	2 (18.2)
All the time
*Quantity* (Question 4)
Never	7 (58.3)	8 (80)	6 (54.5)
Small	4 (33)	1 (10)	1 (9.1)
Moderate	0 (0)	1 (10)	4 (36.4)
Large	1 (8.3)	0 (0)	0 (0)
*Impact* (Question 5)
None	7 (58.3)	8 (80)	6 (54.5)
Mild	2 (16.7)	2 (20)	1 (9.1)

Moderate	1 (8.3)	0 (0)	2 (18.2)
Severe	1 (8.3)	0 (0)	2 (18.2)
Very Severe	1 (8.3)	0 (0)	0 (0)
*UI Characterization (Question 6)*
UUI	3 (60)	1 (50)	3 (60)
EUI	2 (40)	1 (50)	1 (20)
MUI	0 (0)	0 (0)	1 (20)
*ICIQ Score*	9.6	9.8	11.8

Domains	Pre-RT vs Post-RT #1		p	Pre-RT vs Post-RT #2		p	Post-RT #1 vs Post-RT #2		p
Domains	(n = 12) vs (n = 10)		p	(n = 12) vs (n = 11)		p	(n = 10) vs (n = 11)		p
Physical	69.0±3.9	83.2±4.7	0.01	69.0±3.9	68.3±5.5	0.9	83.2±4.7	68.3±5.5	0.02
Psychological	63.5±3.2	68.1±4.0	0.1	63.5±3.2	62.5±6.6	1.0	68.1±4.0	62.5±6.6	0.3
Social	64.6±2.3	65.8±5.0	0.7	64.6±2.3	65.1±5.0	0.7	65.8±5.0	65.1±5.0	1.0
Environmental	60.7±2.8	70.9±3.4	0.02	60.7±2.8	59.4±3.5	0.9	70.9±3.4	59.4±3.5	0.02
Overall QoL	62.5±5.5	81.3±4.3	0.02	62.5±5.5	59.1±8.1	0.9	81.3±4.3	59.1±8.1	0.04

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E-mail: revista.fisioterapia@pucpr.br

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[1] *RAM: Doctoral student, e-mail: alinemrib@gmail.com