Lilleby W, Fosså S D, Waehre H R, Olsen D R
Department of Oncology, The Norwegian Radium Hospital, Oslo.
Int J Radiat Oncol Biol Phys. 1999 Mar 1;43(4):735-43. doi: 10.1016/s0360-3016(98)00475-1.
To assess morbidity, side effects, and quality of life (QoL) in patients treated for localized prostate cancer with curative aim.
This descriptive cross-sectional study comprises 154 patients who had undergone definitive radiotherapy (RAD) and 108 patients with radical prostatectomy (PRECT) at the Norwegian Radium Hospital during 1987-1995. At least 1 year after treatment the patients completed several questionnaires assessing quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 instrument [EORTC QLQ-C30]), lower urinary tract symptoms (LUTS): International Prostate Symptom Score (IPSS), or sexuality (selected questions from the Psychosocial Adjustment to Illness Scale [PAIS]). Urinary incontinence and bowel distress were evaluated by ad hoc constructed questionnaires. A control group (OBS) consisted of 38 patients following the watch-and-wait policy.
Twenty percent of the patients from the RAD Group had moderate (14%) or severe (6%) LUTS as compared to 12% in the PRECT group. However, 35% of men from the latter group reported moderate to severe urinary incontinence. "Overall" sexuality was moderately or severely impaired in 71% of the PRECT and 50% of the RAD patients. In the former group high age was correlated with erectile impotency (p < 0.001). In the RAD comorbidity was associated with erectile impotency (p < 0.001). Between 13-38% of the patients recorded moderate or severe bowel distress (blood per rectum: 13%; bowel cramps: 26%; flatulence: 38%), without significant differences comparing patients who had received conventional small 4-field box radiotherapy and patients who had undergone strictly conformal radiotherapy. Despite malignancy and/or treatment-related morbidity, QoL was comparable in both groups with respectively 9% and 6% RAD and PRECT patients, reporting moderately or severely impaired QoL. In the multivariate analysis physical function, emotional function and fatigue were significantly correlated with QoL, whereas sexuality, lower urinary symptoms, and urinary incontinence correlated with QoL only in the univariate analysis.
In spite of considerable malignancy and/or treatment-related morbidity QoL was good or only slightly impaired in the majority of patients with localized prostate cancer who presented with stable disease > 1 year after definitive radiotherapy or radical prostatectomy with no difference as compared to the age-matched normal population. Clinicians should be aware of the fact that general QoL dimensions (physical function, emotional function, fatigue) are as a rule of greater significance for QoL than sexuality and lower urinary tract symptoms.
评估以治愈为目的接受局部前列腺癌治疗的患者的发病率、副作用及生活质量（QoL）。
这项描述性横断面研究纳入了1987年至1995年间在挪威镭医院接受根治性放疗（RAD）的154例患者以及接受根治性前列腺切除术（PRECT）的108例患者。治疗后至少1年，患者完成了几份评估生活质量的问卷（欧洲癌症研究与治疗组织QLQ-C30量表 [EORTC QLQ-C30]）、下尿路症状（LUTS）：国际前列腺症状评分（IPSS）或性功能（来自疾病心理社会适应量表 [PAIS] 的选定问题）。尿失禁和肠道不适通过专门构建的问卷进行评估。一个对照组（OBS）由38例采取观察等待策略的患者组成。
RAD组20%的患者有中度（占14%）或重度（占6%）LUTS，而PRECT组为12%。然而，后一组35%的男性报告有中度至重度尿失禁。71%的接受PRECT治疗的患者和50%接受RAD治疗的患者的“总体”性功能受到中度或重度损害。在前一组中，高龄与勃起功能障碍相关（p < 0.001）。在RAD组中，合并症与勃起功能障碍相关（p < 0.001）。13%至38%的患者记录有中度或重度肠道不适（便血：13%；肠道痉挛：26%；肠胃胀气：38%），接受传统小四野盒式放疗的患者与接受严格适形放疗的患者相比无显著差异。尽管存在恶性肿瘤和/或与治疗相关的发病率，但两组的生活质量相当，分别有9%和6%的RAD组和PRECT组患者报告生活质量受到中度或重度损害。在多变量分析中，身体功能、情绪功能和疲劳与生活质量显著相关，而性功能、下尿路症状和尿失禁仅在单变量分析中与生活质量相关。
尽管存在相当程度的恶性肿瘤和/或与治疗相关的发病率，但大多数局部前列腺癌患者在根治性放疗或根治性前列腺切除术后疾病稳定超过1年，其生活质量良好或仅略有受损，与年龄匹配的正常人群相比无差异。临床医生应意识到，一般生活质量维度（身体功能、情绪功能、疲劳）通常比性功能和下尿路症状对生活质量更具重要性。
