Stanford J L, Feng Z, Hamilton A S, Gilliland F D, Stephenson R A, Eley J W, Albertsen P C, Harlan L C, Potosky A L
Fred Hutchinson Cancer Research Center, Department of Epidemiology, University of Washington, Seattle 98109-1024, USA.
JAMA. 2000 Jan 19;283(3):354-60. doi: 10.1001/jama.283.3.354.
Patients with prostate cancer and their physicians need knowledge of treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patients.
To measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer.
The Prostate Cancer Outcomes Study, a population-based longitudinal cohort study with up to 24 months of follow-up.
Population-based cancer registries in 6 geographic regions of the United States.
A total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease.
Distribution of and change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis.
At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after surgery varied according to whether the procedure was nerve sparing (65.6% of non-nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve-sparing). At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age (39.0% of men aged <60 years vs 15.3 %-21.7% of older men were potent at > or =18 months [P<.001]; 13.8% of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at > or =18 months [P = .03]), and sexual function also varied by race (38.4% of black men reported firm erections at > or =18 months vs 25.9% of Hispanic and 21.3% of white men; P = .001).
Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.
前列腺癌患者及其医生需要了解治疗方案及其潜在并发症，但在未经过筛选的基于人群的患者队列中，关于并发症的可用数据有限。
测量因临床局限性前列腺癌接受根治性前列腺切除术的男性患者的泌尿和性功能变化。
前列腺癌结局研究，一项基于人群的纵向队列研究，随访时间长达24个月。
美国6个地理区域基于人群的癌症登记处。
共有1291名年龄在39至79岁之间的黑人、白人和西班牙裔男性，他们在1994年10月1日至1995年10月31日期间被诊断为原发性前列腺癌，并在诊断后6个月内接受了针对临床局限性疾病的根治性前列腺切除术。
患者在基线以及诊断后6、12和24个月报告的泌尿和性功能指标的分布及变化。
在根治性前列腺切除术后18个月或更长时间，8.4%的男性出现尿失禁，59.9%的男性出现阳痿。在术前有性功能的男性中，术后18个月或更长时间报告阳痿的男性比例因手术是否保留神经而异（非保留神经手术的为65.6%，单侧保留神经手术的为58.6%，双侧保留神经手术的为56.0%）。术后18个月或更长时间，41.9%的患者报告其性功能存在中度至重度问题。性功能和泌尿功能均因年龄而异（年龄<60岁的男性中，39.0%在18个月或更长时间有性功能，而年龄较大男性中这一比例为15.3%-21.7%[P<.001]；75-79岁的男性中，13.8%在18个月或更长时间出现最高程度的尿失禁，而较年轻男性中这一比例为0.7%-3.6%[P =.03]），性功能也因种族而异（18个月或更长时间报告有坚挺勃起的黑人男性比例为38.4%，而西班牙裔男性为25.9%，白人男性为21.3%；P =.001）。
我们的研究表明，根治性前列腺切除术与显著的勃起功能障碍和一定程度的泌尿功能下降有关。这些结果可能对社区医生及其面临艰难治疗决策的前列腺癌患者特别有帮助。
