Anastasiadis Aristotelis G, Sachdev Reena, Salomon Laurent, Ghafar Mohamed A, Stisser Brian C, Shabsigh Ridwan, Katz Aaron E
Department of Urology, Columbia University Health Sciences, 161 Fort Washington Avenue, Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA.
J Cancer Res Clin Oncol. 2003 Dec;129(12):676-82. doi: 10.1007/s00432-003-0472-4. Epub 2003 Oct 21.
Recent advances in cryosurgery of the prostate have led to the ability to treat tumors successfully with decreased morbidity. The patients' perspectives of this relatively new technique, however, have not yet been addressed. The purpose of this study was to compare health related quality of life (QoL) as well as prostate-associated symptoms in patients after primary and salvage cryoablation for clinically localized prostate cancer using a self-administered questionnaire.
A total of 131 consecutive patients who underwent cryoablation of the prostate between 1997 and 2001 were included in this confidential mailing study. The patients were either (a) patients with localized prostate cancer with contraindications for radical surgery, including patients refusing other forms of therapy, or (b) had locally recurrent prostate cancer after failure of radiation therapy. All patients received 3 months of neoadjuvant androgen deprivation therapy prior to cryosurgery and were surgically treated by the same surgeon using an argon-based system. We used the EORTC QLQ-C30, a commonly used, multidimensional instrument together with a supplementing, prostate-cancer-specific module.
Eighty-one of the 131 patients (response rate 62%) returned the questionnaires. The two groups were comparable regarding age (mean age 72.8 vs 70.1 for the primary and the salvage group, respectively; p=0.22). The overall QoL scores were high in both groups. Primary cryotherapy patients fared significantly better regarding physical (p=0.005) and social (p=0.024) functioning compared with salvage cryotherapy patients. The most prominent prostate-related symptom in both patient groups was sexual dysfunction, followed by urinary symptoms, which were significantly more severe in the salvage group (p=0.001). Incontinence rates were 5.9 and 10% in the primary and the salvage group, respectively. Severe erectile dysfunction was reported in 86 and 90% of the primary and the salvage group, respectively.
The present study demonstrates that, in selected patients, cryotherapy is a treatment option which has a functional outcome comparable to traditionally used prostate cancer treatments. More information regarding QoL is necessary for appropriate patient counseling and individual decision-making in the presence of various treatment alternatives.
前列腺冷冻手术的最新进展已使其能够在降低发病率的情况下成功治疗肿瘤。然而，患者对这项相对新技术的看法尚未得到探讨。本研究的目的是使用一份自行填写的问卷，比较临床局限性前列腺癌患者在初次和挽救性冷冻消融术后与健康相关的生活质量（QoL）以及前列腺相关症状。
本项保密邮寄研究纳入了1997年至2001年间连续接受前列腺冷冻消融术的131例患者。这些患者要么是（a）患有局限性前列腺癌且有根治性手术禁忌症的患者，包括拒绝其他治疗形式的患者，要么是（b）放射治疗失败后局部复发性前列腺癌患者。所有患者在冷冻手术前均接受3个月的新辅助雄激素剥夺治疗，并由同一位外科医生使用基于氩气的系统进行手术治疗。我们使用了欧洲癌症研究与治疗组织（EORTC）的QLQ-C30，这是一种常用的多维工具，并辅以一个前列腺癌特异性模块。
131例患者中有81例（回复率62%）返回了问卷。两组患者在年龄方面具有可比性（初次治疗组平均年龄为72.8岁，挽救性治疗组平均年龄为70.1岁；p = 0.22）。两组患者的总体生活质量评分都很高。与挽救性冷冻治疗患者相比，初次冷冻治疗患者在身体功能（p = 0.005）和社会功能（p = 0.024）方面表现明显更好。两组患者中最突出的前列腺相关症状是性功能障碍，其次是泌尿系统症状，在挽救性治疗组中这些症状明显更严重（p = 0.001）。初次治疗组和挽救性治疗组的尿失禁发生率分别为5.9%和10%。初次治疗组和挽救性治疗组分别有86%和90%的患者报告有严重勃起功能障碍。
本研究表明，对于选定的患者，冷冻治疗是一种治疗选择，其功能结局与传统使用的前列腺癌治疗方法相当。在存在多种治疗选择的情况下，为患者提供适当的咨询和个性化决策需要更多关于生活质量的信息。
