Patient-reported quality of life after stereotactic body radiation therapy versus moderate hypofractionation for clinically localized prostate cancer

Background and purpose Evaluate changes in bowel, urinary and sexual patient-reported quality of life following treatment with moderately hypofractionated radiotherapy (<5 Gray/fraction) or stereotactic body radiation therapy (SBRT;5–10 Gray/fraction) for prostate cancer. Materials and methods In a pooled multi-institutional analysis of men treated with moderate hypofractionation or SBRT, we compared minimally detectable difference in bowel, urinary and sexual quality of life at 1 and 2 years using chi-squared analysis and logistic regression. Results 378 men received moderate hypofractionation compared to 534 men who received SBRT. After 1 year, patients receiving moderate hypofractionation were more likely to experience worsening in bowel symptoms (39.5%) compared to SBRT (32.5%; p = .06), with a larger difference at 2 years (37.4% versus 25.3%, p = .002). Similarly, patients receiving moderate fractionation had worsening urinary symptom score compared to patients who underwent SBRT at 1 and 2 years (34.7% versus 23.1%, p < .001; and 32.8% versus 14.0%, p < .001). There was no difference in sexual symptom score at 1 or 2 years. After adjusting for age and cancer characteristics, patients receiving SBRT were less likely to experience worsening urinary symptom scores at 2 years (odds ratio: 0.24[95%CI: 0.07–0.79]). Conclusions Patients who received SBRT or moderate hypofractionation have similar patient-reported change in bowel and sexual symptoms, although there was worse change in urinary symptoms for patients receiving moderate hypofractionation.