Litwin Mark S, Gore John L, Kwan Lorna, Brandeis Judson M, Lee Steve P, Withers H Rodney, Reiter Robert E
Department of Urology, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, California 90095, USA.
Cancer. 2007 Jun 1;109(11):2239-47. doi: 10.1002/cncr.22676.
The primary treatments for clinically localized prostate cancer confer equivalent cancer control for most patients but disparate side effects. In the current study, the authors sought to compare health-related quality of life (HRQOL) outcomes after the most commonly used treatments.
A total of 580 men completed the Medical Outcomes Study Short Form-36, the University of California-Los Angeles (UCLA) Prostate Cancer Index, and the American Urological Association Symptom Index before and through 24 months after treatment with radical prostatectomy (RP), external beam radiation therapy (EBRT), or brachytherapy (BT).
General HRQOL did not appear to be affected by treatment. Obstructive and irritative urinary symptoms were more common after BT (P<.001). Urinary control and sexual function were better after EBRT than BT (P<.001 and P=.02, respectively) and better after BT than RP (P<.001 and P=.01, respectively). Among potent men, recovery of sexual function was best after EBRT and was equivalent after bilateral nerve-sparing surgery or BT. Sexual bother was more common than urinary or bowel bother after all 3 treatments. Bowel dysfunction was more common after EBRT or BT than RP (P<.001).
In the current study, treatment for localized prostate cancer was found to differentially affect HRQOL outcomes. Urinary control and sexual function were better after EBRT, although bilateral nerve-sparing surgery diminished these differences among potent men undergoing RP. BT caused more obstructive and irritative symptoms, while both forms of radiation caused more bowel dysfunction. These results may inform medical decision-making in men with localized prostate cancer.
临床上局限性前列腺癌的主要治疗方法对大多数患者而言，在癌症控制方面效果相当，但副作用却不尽相同。在本研究中，作者试图比较最常用治疗方法后的健康相关生活质量（HRQOL）结果。
共有580名男性在接受根治性前列腺切除术（RP）、外照射放疗（EBRT）或近距离放疗（BT）治疗前及治疗后24个月内，完成了医学结局研究简表36、加利福尼亚大学洛杉矶分校（UCLA）前列腺癌指数和美国泌尿外科协会症状指数。
总体健康相关生活质量似乎未受治疗影响。BT治疗后梗阻性和刺激性尿路症状更为常见（P<0.001）。EBRT治疗后的尿控和性功能比BT更好（分别为P<0.001和P = 0.02），且BT治疗后的尿控和性功能比RP更好（分别为P<0.001和P = 0.01）。在性功能正常的男性中，EBRT治疗后性功能恢复最佳，双侧保留神经手术或BT治疗后的性功能恢复相当。在所有三种治疗后，性困扰比尿路或肠道困扰更为常见。EBRT或BT治疗后的肠道功能障碍比RP更常见（P<0.001）。
在本研究中，发现局限性前列腺癌的治疗对健康相关生活质量结果有不同影响。EBRT治疗后的尿控和性功能更好，尽管双侧保留神经手术缩小了接受RP治疗的性功能正常男性之间的这些差异。BT导致更多的梗阻性和刺激性症状，而两种放疗形式均导致更多的肠道功能障碍。这些结果可能为局限性前列腺癌男性的医疗决策提供参考。
