Long term rectal function after high-dose prostatecancer radiotherapy: Results from a prospective cohort study

Abstract Purpose To prospectively evaluate long-term late rectal bleeding (lrb) and faecal incontinence (linc) after high-dose radiotherapy (RT) for prostate cancer in the AIROPROS 0102 population, and to assess clinical/dosimetric risk factors. Materials and methods Questionnaires of 515 patients with G0 baseline incontinence and bleeding scores (follow-up ⩾6years) were analysed. Correlations between lrb/linc and many clinical and dosimetric parameters were investigated by univariate and multivariate logistic analyses. The correlation between lrb/linc and symptoms during the first 3years after RT was also investigated. Results Of 515 patients lrb G1, G2 and G3 was found in 32 (6.1%), 2 (0.4%) and 3 (0.6%) patients while linc G1, G2 and G3 was detected in 50 (9.7%), 3 (0.6%) and 3 (0.6%), respectively. The prevalence of G2–G3 lrb events was significantly reduced compared to the first 3-years (1% vs 2.7%, p =0.016) ⩾G1 lrb was significantly associated with V75Gy (OR=1.07). In multivariate analysis, ⩾G1 linc was associated with V40Gy (OR=1.015), use of antihypertensive medication (OR=0.38), abdominal surgery before RT (OR=4.7), haemorrhoids (OR=2.6), and G2–G3 acute faecal incontinence (OR=4.4), a nomogram to predict the risk of long-term ⩾G1 linc was proposed. Importantly, the prevalence of ⩾G1 linc was significantly correlated with the mean incontinence score during the first 3years after RT (OR=16.3). Conclusions Long-term (median: 7years) rectal symptoms are prevalently mild and strongly correlated with moderate/severe events occurring in the first 3years after RT. Linc was associated with several risk factors.