Quality of Life After Salvage Radical Prostatectomy Post-Radiotherapy or Focal Therapy

Overview

This study compared long-term health-related quality of life (HRQOL) outcomes in patients undergoing salvage radical prostatectomy (sRP) after primary treatment with either radiotherapy (RT) or focal therapy (FT). Results showed no significant differences in general HRQOL, functional outcomes, or symptom burden between the two groups at a median follow-up of 32 months.

Background

Salvage radical prostatectomy is a treatment option for recurrent prostate cancer following primary non-surgical therapies such as radiotherapy or focal therapy. While sRP offers favorable cancer control, concerns remain regarding its functional outcomes and impact on quality of life, with earlier reports indicating high urinary incontinence rates. Recent data suggest improved continence rates, particularly after focal therapy, but patient-reported outcomes remain underreported. Understanding HRQOL after sRP is critical for informed clinical decision-making.

Data Highlights

Key Findings

• No significant difference in preoperative or postoperative general HRQOL between patients treated with RT or FT prior to sRP.
• Similar rates of patients reporting good general HRQOL (GHS ≥ 70) in both groups pre- and post-surgery.
• Functional and symptom subscales of EORTC QLQ-C30 and prostate-specific QLQ-PR25 showed no significant differences between groups.
• Largest declines post-surgery were observed in social and role functioning domains in both groups.
• Fatigue and dyspnea symptoms improved more notably in the FT-sRP group compared to the RT-sRP group.
• Multivariable analysis did not identify primary treatment type or time interval to sRP as predictors of good general HRQOL.

Clinical Implications

These findings suggest that salvage radical prostatectomy yields comparable long-term quality of life outcomes regardless of whether patients initially received radiotherapy or focal therapy. Clinicians can counsel patients that HRQOL and functional outcomes after sRP are similar across these primary treatment modalities, supporting sRP as a viable salvage option. Attention should be given to social and role functioning declines postoperatively, with supportive care interventions considered.

Conclusion

Salvage radical prostatectomy provides similar long-term health-related quality of life outcomes in patients with recurrent prostate cancer after either radiotherapy or focal therapy. This supports its use as an effective salvage treatment without significant differences in patient-reported quality of life based on primary treatment modality.

References

1. Study Authors/Institution/Year -- Quality of Life Outcomes After Salvage Radical Prostatectomy