External beam radiotherapy of prostate cancer with or without high dose-rate brachytherapy: the Norwegian experience with long-term urinary and bowel adverse effects


  • Trude B. Wedde Departement of Oncology, Oslo University Hospital, Oslo, Norway
  • Milada C. Smaastuen Departement of Health Science, Oslo Metropolitan University, Oslo, Norway
  • Kari Vatne Departement of Oncology, Oslo University Hospital, Oslo, Norway
  • Melanie Birthe Schulz-Jaavall Departement of Oncology, Oslo University Hospital, Oslo, Norway
  • Sophie D. Fosså National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
  • Wolfgang LH. Lilleby Departement of Oncology, Oslo University Hospital, Oslo, Norway




Brachytherapy, prostate cancer, patient-report outcomes, adverse effects, epic-26, QoL


Background: There are few studies utilizing the Expanded Prostate Index Composite questionnaire-26 (EPIC-26) questionnaire to examine the long-term association between Domain Summary Scores (DSSs) and Quality of Life (QoL) after External Beam Radiation Therapy (EBRT, 3DCRT [3D conventional radiotherapy]/IMRT [intensity modulated radiation therapy]) versus EBRT combined with High-Dose-Rate Brachytherapy (BT+, 3DCRT [3D conventional radiotherapy]/IMRT). In this cross-sectional study we compare long-term adverse effects and QoL after BT+ with EBRT.
Methods: Prostate Cancer Survivors who at least 5 years previously, had undergone BT+ at Oslo University Hospital between 2004 and 2010 (n = 259) or EBRT (multicentre cohort) between 2009 and 2010 (n = 99) completed a questionnaire containing EPIC-26, Short Form-12 and questions regarding comorbidity/social status. Results were presented as DSSs and Physical/Mental Composite Scores of QoL (PCS/MCS). Regression analyses explored firstly the associations between treatment modality and DSSs and secondly the impact of DSSs on QoL. We estimated the proportions of patients with big/moderate problems. Clinical relevance was set according to the lowest limit of published Minimal Important Differences. P-values <0.05 were considered statistically significant.
Results: In multivariate analysis, only the urinary incontinence DSS remained statistically (P < 0.05) and clinically significantly greater after BT+ than EBRT (90 vs. 83). The number of men with moderate/big urinary or bowel problems was halved after BT+ (P < 0.05). The number of patients with impaired PCS (score < 45) were lower in the BT+ group than the EBRT group (P = 0.02). Regression analysis showed that decreasing levels of bowel and urinary irritation/obstructive DSSs predicted worsening of PCS (P < 0.001) and MCS (P = 0.007), respectively.
Conclusions: Dose-escalated radiotherapy by BT did not negatively impact long-term adverse effects, substantial problems or QoL compared with EBRT. Future randomised studies using improved EBRT techniques are needed.


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Wedde, T. B., Smaastuen, M. C., Vatne, K., Schulz-Jaavall, M. B., Fosså, S. D., & Lilleby, W. L. (2023). External beam radiotherapy of prostate cancer with or without high dose-rate brachytherapy: the Norwegian experience with long-term urinary and bowel adverse effects. Scandinavian Journal of Urology, 58, 68–75. https://doi.org/10.2340/sju.v58.9571



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