Pinkawa Michael, Fischedick Karin, Asadpour Branka, Gagel Bernd, Piroth Marc D, Nussen Sandra, Eble Michael J
Department of Radiotherapy, RWTH Aachen University, Aachen, Germany.
Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):83-9. doi: 10.1016/j.ijrobp.2007.05.051. Epub 2007 Sep 12.
To assess the impact of prostate volume on health-related quality of life (HRQOL) before and at different intervals after radiotherapy for prostate cancer.
A group of 204 patients was surveyed prospectively before (Time A), at the last day (Time B), 2 months after (Time C), and 16 months (median) after (Time D) radiotherapy, with a validated questionnaire (Expanded Prostate Cancer Index Composite). The group was divided into subgroups with a small (11-43 cm(3)) and a large (44-151 cm(3)) prostate volume.
Patients with large prostates presented with lower urinary bother scores (median 79 vs. 89; p = 0.01) before treatment. Urinary function/bother scores for patients with large prostates decreased significantly compared to patients with small prostates due to irritative/obstructive symptoms only at Time B (pain with urination more than once daily in 48% vs. 18%; p < 0.01). Health-related quality of life did not differ significantly between both patient groups at Times C and D. In contrast to a large prostate, a small initial bladder volume (with associated higher dose-volume load) was predictive for lower urinary bother scores both in the acute and late phase; at Time B it predisposed for pollakiuria but not for pain. Patients with neoadjuvant hormonal therapy reached significantly lower HRQOL scores in several domains (affecting only incontinence in the urinary domain), despite a smaller prostate volume (34 cm(3) vs. 47 cm(3); p < 0.01).
Patients with a large prostate volume have a great risk of irritative/obstructive symptoms (particularly dysuria) in the acute radiotherapy phase. These symptoms recover rapidly and do not influence long-term HRQOL.
评估前列腺体积对前列腺癌放疗前及放疗后不同时间间隔的健康相关生活质量（HRQOL）的影响。
前瞻性地对一组204例患者在放疗前（时间A）、放疗最后一天（时间B）、放疗后2个月（时间C）和放疗后16个月（中位数，时间D）进行调查，使用经过验证的问卷（扩展前列腺癌指数综合问卷）。将该组患者分为前列腺体积小（11 - 43 cm³）和前列腺体积大（44 - 151 cm³）的亚组。
前列腺体积大的患者在治疗前的尿路困扰评分较低（中位数79对89；p = 0.01）。仅在时间B时，由于刺激性/梗阻性症状，前列腺体积大的患者的泌尿功能/困扰评分与前列腺体积小的患者相比显著下降（每天排尿疼痛超过一次的比例为48%对18%；p < 0.01）。在时间C和D时，两组患者的健康相关生活质量没有显著差异。与前列腺体积大相反，初始膀胱体积小（伴有更高的剂量 - 体积负荷）在急性期和晚期均是较低尿路困扰评分的预测因素；在时间B时，它易导致尿频但不会引起疼痛。新辅助激素治疗的患者在几个领域的HRQOL评分显著较低（仅在泌尿领域影响尿失禁），尽管前列腺体积较小（34 cm³对47 cm³；p < 0.01）。
前列腺体积大的患者在急性放疗期有出现刺激性/梗阻性症状（特别是排尿困难）的高风险。这些症状恢复迅速，且不影响长期的健康相关生活质量。
