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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Karin Ahlberg, University of Gothenburg
- Second opponent: Senior Consultant Karin A. Semb, Vestfold Hospital Trust
- Third member and chair of the evaluation committee: Associate Professor Eduard Baco, University of Oslo
Chair of the Defence
Professor Ludvig A. Munthe, University of Oslo
Principal Supervisor
Wolfgang H. Lilleby, Oslo University Hospital
Summary
Radiotherapy is an internationally acknowledged treatment for men with localized prostate cancer. However, there is a paucity of evidence regarding the assumed clinical benefit of adding internal radiation therapy (high-dose rate brachytherapy) in combination with external beam radiation therapy (EBRT), referred to as BT+, in this patient group.
The aims of the thesis were to investigate long-term mortality, patient-reported late adverse effects and quality of life after BT+ versus EBRT alone in patients with curative prostate cancer. Data were collected from the Brachytherapy Registry at Oslo University Hospital, the Scandinavian Prostate Cancer Group Trial 7, and the Norwegian Urological Cancer Group Trial 7. Cause of death was obtained from the Norwegian Death Registry.
Long-term overall survival was significantly higher after BT+, with a 1.6-fold reduced risk of death compared to EBRT only. Significantly more men treated with EBRT alone died from prostate cancer, with a 3.5-fold increased risk of death compared to BT+.
Patient-reported late adverse effects were assessed using the Expanded Prostate Index Composite-26 and the Short Form-12 questionnaires. Urinary incontinence dysfunction was clinically less after BT+ based on Minimal Important Difference between the groups. No difference was seen for bowel dysfunction. More men reported substantial urinary and bowel problems after EBRT only.
Although patients reported less sexual dysfunction after BT+, it did not affect their perception of sexual dysfunction as a substantial problem. Physical quality of life was poorer after EBRT alone, with almost 50% reporting impaired physical health. Compared to the general population, mental health was above average.
Overall, BT+ appears to be a favourable treatment option for selected patients meeting the inclusion and exclusion criteria. Dose-escalation by this method of radiation therapy resulted in reduced mortality without increased adverse effects.
Additional information
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