Radiation therapy is traditionally associated with bowel side effects and erectile dysfunction. As noted previously, the technique has evolved tremendously with conformal beam planning, dose escalation and frequent use of neoadjuvant/ adjuvant androgen deprivation. Thus, the era studied and technique used will significantly affect QOL results.
In the PCOS study,52 bowel function decreased at 6 months but improved to baseline by 24 months. Urinary function and bother were essentially not affected by treatment. Sexual function declined over time, such that by 24 months, 43% of all men with pretreatment potency were no longer potent. Bother assessment also declined over time. Other studies have also documented this pattern of sexual function decline.49'53-55 However, reports of impotence after conformal beam radiation therapy have been lower (13-29%)56-58 and etal. reported decreased bowel complications (34% to 10%, P <0.04) for moderate to major changes in bowel function. The importance of technique were also demonstrated by Hanlon et al.59 in a cross-sectional study of three-dimensional (3D) conformal radiation therapy with or without whole pelvis boost. Patients treated with pelvic boost reported more rectal urgency, use of pads for bowel incontinence and lower overall satisfaction.
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