• Gregory S Merrick, Wayne M Butler, Kent E Wallner, Brian C Murray, Zachariah Allen, and Robert W Galbreath.
• Schiffler Cancer Center, Wheeling Hospital, Wheeling, WV 26003-6300, USA. SchifflerCancerCenter@wheelinghospital.com
• Int. J. Radiat. Oncol. Biol. Phys. 2004 Jan 1; 58 (1): 68-74.

PurposeRecent clinical studies have reported a relationship between the use of hormonal therapy and degradation in rectal function after external beam radiotherapy. Using a patient-administered quality-of-life instrument, we evaluated the effect of hormonal therapy on late rectal function after permanent prostate brachytherapy with or without supplemental external beam radiotherapy.Methods And MaterialsA total of 189 patients were mailed the Rectal Function Assessment Score (R-FAS), which consists of nine questions (score range 0-27, with higher scores indicative of poorer bowel function). Of the 189 surveys sent out, 187 (98.4%) were returned. Of the 187 patients, 149 (79.7%) were hormone naive, and 38 (20.3%) had received hormonal manipulation (median duration 4 months, range 3-36). The median follow-up for the entire group was 66.3 months. The effect of hormonal therapy on bowel function was evaluated by comparing the R-FAS scores across time, by each of the individual nine questions, and by means of a summary question evaluating the patient's perception of overall bowel function. The two groups were also evaluated in terms of clinical, treatment, and dosimetric parameters, including follow-up, age, Gleason score, clinical stage, pretreatment prostate-specific antigen level, number of pretreatment bowel movements/d, prostate volume, and rectal dosimetry.ResultsThe two groups were well matched in all clinical, treatment, and dosimetric parameters, except the patients receiving hormonal therapy had a statistically shorter follow-up (63.9 vs. 69.4 months, p <0.001) and higher pretreatment prostate-specific antigen level (12.0 vs. 9.8 ng/mL, p = 0.024). The R-FAS scores for the hormone-naive and hormonally manipulated patients were comparable (3.76 vs. 4.55, p = 0.083). In terms of the nine individual R-FAS questions, no statistically significant difference was reported for any question when stratified by hormonal status, including rectal bleeding (p = 0.735). Only 12% and 13% of hormone-naive and hormonally manipulated patients, respectively, reported bowel function to be worse after implantation. With time, a trend for improvement in the R-FAS was noted in both cohorts.ConclusionAfter permanent prostate brachytherapy, no statistically significant difference in bowel habits was discerned when stratified by hormonal status. In addition, only 12% of brachytherapy patients reported deterioration in bowel function after implantation.

31 keywords...

hide…