Fatigue is a common and debilitating problem for cancer patients. It is associated
with cancer or its treatment. Evidence suggests fatigue may be prolonged after
treatment for some cancers and could be associated with a host systemic
inflammatory response. Prostate cancer is the commonest male cancer however little
is known about fatigue and its associations in this population.
To explore the incidence of fatigue and its associations during and after treatment for
Four studies were conducted: Study A, was a pilot study which examined fatigue
over 3 months after different treatments for localised prostate cancer (radiotherapy,
brachytherapy and androgen deprivation, n=45). Study B focussed on fatigue over 12
months after brachytherapy (n=51). Two cross sectional postal surveys explored
fatigue in recurrence free prostate cancer survivors (Study C, n=443) and hormone
controlled prostate cancer (Study D, n=198). Throughout, fatigue was assessed using
the Brief Fatigue Inventory and a case definition of clinically significant fatigue
(CSF) was also constructed and applied in Studies A and B.
Study A found CSF increased after treatment but returned to baseline 3 months after
radiotherapy, whereas it appeared to be prolonged after brachytherapy. CSF was not
associated with C reactive protein or interleukin-6. Study B found CSF increased
between baseline and 1 month after brachytherapy (6 vs. 29%, p=0.001) and was
higher than the non-cancer comparison group (29 vs. 4% p=0.001). CSF returned
towards baseline levels by 6 months. There were no baseline predictors of
developing CSF. Study C found 29% of recurrence free prostate cancer survivors had
fatigue after radiotherapy or radical prostatectomy (33 vs. 22% p=0.024) but it was
not independently associated with treatment received after controlling for other
factors. 43% of men with hormone controlled prostate cancer had fatigue in Study D.
Fatigue is an important symptom in men treated for prostate cancer but resolves
within months of brachytherapy. Almost one third of recurrence free survivors have
fatigue but it does not appear to be related to the type of treatment received. Fatigue
is most prevalent in men with hormone controlled prostate cancer.