Wright J L, Lin D W, Cowan J E, Carroll P R, Litwin M S
Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
Prostate Cancer Prostatic Dis. 2008;11(1):67-73. doi: 10.1038/sj.pcan.4500980. Epub 2007 May 22.
Urinary and sexual function and bother are important outcomes following radical prostatectomy (RP). Since urinary and sexual function are age-related, post-operative bother may vary by age. This study explores the disease-specific quality-of-life outcomes in young men compared with older men undergoing RP. Using CaPSURE data, we identified men who underwent RP and completed the UCLA Prostate Cancer Index (PCI) before and 1-year post-RP. Men were stratified by age (< 55 years, 55-64, > or = 65). Multivariate regression models were created: a linear model for predictors of PCI scores and a logistic model for predictors of severe declines in PCI domains. Younger men scored significantly better than older men in urinary function (P=0.04), urinary bother (P=0.02) and sexual function (P<0.0001) 1-year post-RP. Severe declines in urinary bother (odds ratio (OR)=1.54, 1.01-2.35) and sexual function (OR=3.20, 1.97-5.19) were more common in men > or = 65 years. Men with relationships had less urinary bother (P=0.03) and were less likely to experience severe worsening of urinary bother (OR=0.32, 0.17-0.60) while having a greater risk of severe worsening of sexual bother (OR=2.74, 1.28-5.89). The use of sexual aids was associated with worse sexual bother (P<0.0001) and greater risk of severe worsening of sexual bother (OR=2.29, 1.54-3.30). Baseline PCI scores were independent predictors in all models. One year after RP, younger men (age < 55) have similar, or better, urinary and sexual function and bother. Baseline scores are strongly associated with post-RP scores and severity of declines. Current relationships and use of sexual aids have significant roles in post-RP bother.
根治性前列腺切除术（RP）后，泌尿和性功能以及相关困扰是重要的预后指标。由于泌尿和性功能与年龄相关，术后困扰可能因年龄而异。本研究探讨了与接受RP的老年男性相比，年轻男性特定疾病的生活质量预后情况。利用CaPSURE数据，我们确定了接受RP并在RP前及术后1年完成加州大学洛杉矶分校前列腺癌指数（PCI）的男性。男性按年龄分层（<55岁、55 - 64岁、≥65岁）。创建了多变量回归模型：一个用于PCI评分预测因子的线性模型和一个用于PCI各领域严重下降预测因子的逻辑模型。RP术后1年，年轻男性在泌尿功能（P = 0.04）、泌尿困扰（P = 0.02）和性功能（P < 0.0001）方面的得分显著高于老年男性。在≥65岁的男性中，泌尿困扰（优势比[OR]=1.54，1.01 - 2.35）和性功能（OR = 3.20，1.97 - 5.19）的严重下降更为常见。有伴侣的男性泌尿困扰较少（P = 0.03），且泌尿困扰严重恶化的可能性较小（OR = 0.32，0.17 - 0.60），而性困扰严重恶化的风险较大（OR = 2.74，1.28 - 5.89）。使用性辅助器具与更严重的性困扰相关（P < 0.0001），且性困扰严重恶化的风险更高（OR = 2.29，1.54 - 3.30）。基线PCI评分在所有模型中都是独立的预测因子。RP术后1年，年轻男性（年龄<55岁）的泌尿和性功能以及困扰情况相似或更好。基线评分与RP术后评分及下降严重程度密切相关。当前的伴侣关系和性辅助器具的使用在RP术后困扰中起重要作用。
