S2662
RTT - Patient experience and quality of life
ESTRO 2026
Digital Poster Highlight 2132
Predictors of GI function in individuals with prostate cancer: revealing wellbeing needs and personalising interventions Sophie E Alexander 1,2 , Helen A McNair 1,2 , Jayde Nartey 1 , Uwe Oelfke 3 , Alison C Tree 4,2 1 Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom. 2 Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom. 3 The Joint Department of Physics, The ROyal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom. 4 Uro-oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom Purpose/Objective: Our prior scoping review identified 6 gastrointestinal (GI)-factors (measurable and defined cause of altered lower GI-function) most likely to impact individuals undergoing radiotherapy (RT) for localised prostate cancer (PCa): diabetes, obesity, depression, anxiety, physical inactivity and a weak pelvic floor[1]. This project aimed to establish GI-factor prevalence in persons with PCa preparing for RT in our UK department and investigate whether meeting a GI- factor threshold increased the risk of a large rectal volume ( ≥ 90 cm3[2]) on planning CT (pCT). Material/Methods: We developed a comprehensive GI-factor assessment package, employing validated patient-reported questionnaires; PHQ8[3], GAD7[4], Vaizey incontinence[5] and Godin-Shepard Leisure-Time Physical Activity[6]. Questionnaires were embedded into a standard pre-radiotherapy patient proforma, completed immediately prior to initial RT consultation. A sample size for precision was calculated for each GI- factor and the largest used, n = 313. Multiple logistic regression analysis was performed to examine association between a rectal volume ≥ 90 cm3 on pCT and meeting a GI-factor threshold. Age and enema use were also examined. Results: 313 proformas were evaluated. Cohort median (range) age was 71 (48-89) years. Of the 313 patients, 296 received prostate and seminal vesicles +/- pelvic node RT, and 17 had prostate bed +/- pelvic node RT. All patients followed a comfortably full bladder protocol, 167/313 used micro enema rectal preparation and 146/313 had no rectal preparation.Seventy-two patients (23%) had a rectal volume on pCT ≥ 90 cm3.The prevalence of diabetes, physical inactivity and weak pelvic floor aligned with expected rates from the literature; however, obesity rates were higher and anxiety and depression rates lower than predicted (Table 1).Individuals with diabetes were 2.33 times
All men had NCCN high risk disease, 93% Stage III and IV, 30% > Gleason 8. Median age 67 (range 46 – 79). All men received a 15Gy HDR boost, External Beam Radiotherapy Dose was 37.5Gy in 48% and 46Gy in 50%. The median follow up of 92 months. At 84 months the cumulative surviving portion was 88.5% and progression free survival of 80%. At 5 years 71% of men had Gd 0 GU toxicity, and 89% ≤ Gd 2, and 81% had Gd 0 GI and 97% ≤ Gd 2 GI toxicity. The urethral stricture rate was 13%, but the majority of patients required a single intervention. For sexual function ability 85% of men rated themselves as “v poor or poor”, despite this the “ability to enjoy life”, 72% rated themselves as “good or v good”. Overall treatment satisfaction was high with 65% extremely satisfied, 25% satisfied. Conclusion: Our results demonstrate excellent clinic outcomes with high levels of local disease control, than can be achieved with external beam radiotherapy alone, in a cohort of men with aggressive prostate cancer. Toxicity levels are low and patient satisfaction rates high. Despite this brachytherapy usage is declining (3). Considering the global increase in prostate cancer treatment costs (2) brachytherapy may demonstrate cost efficiency with a reduced need for salvage treatments. Health economic results from the PIVOTAL boost study are awaited. References: 1) Gupta D, Rodehier M. Patient satisfaction with service quality as a predictor of survival outcomes in breast cancer. Supportive Care in Cancer. September 2013: 22(1)2) Ellinger J et al. Prostate cancer treatment costs increase more rapidly than for any other cancer - how to reverse the trend? EPMA Journal (2022) 13: 1- 7. 3) Challapalli A et al. The Royal College of Radiologists' Re-Audit of UK Prostate Brachytherapy Delivery. Clinical Oncology (RCR) 46 (2025) Keywords: PROMS, Brachytherapy, Prostate cancer
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