Smith David P, King Madeleine T, Egger Sam, Berry Martin P, Stricker Phillip D, Cozzi Paul, Ward Jeanette, O'Connell Dianne L, Armstrong Bruce K
Cancer Council, Kings Cross, New South Wales 1340, Australia.
BMJ. 2009 Nov 27;339:b4817. doi: 10.1136/bmj.b4817.
To quantify the risk and severity of negative effects of treatment for localised prostate cancer on long term quality of life.
Population based, prospective cohort study with follow-up over three years.
New South Wales, Australia.
Men with localised prostate cancer were eligible if aged less than 70 years, diagnosed between October 2000 and October 2002, and notified to the New South Wales central cancer registry. Controls were randomly selected from the New South Wales electoral roll and matched to cases by age and postcode.
General health specific and disease specific function up to three years after diagnosis, according to the 12 item short form health survey and the University of California, Los Angeles prostate cancer index.
1642 (64%) cases and 495 (63%) eligible and contacted controls took part in the study. After adjustment for confounders, all active treatment groups had low odds of having better sexual function than controls, in particular men on androgen deprivation therapy (adjusted odds ratio (OR) 0.02, 95% CI 0.01 to 0.07). Men treated surgically reported the worst urinary function (adjusted OR 0.17, 95% CI 0.13 to 0.22). Bowel function was poorest in cases who had external beam radiotherapy (adjusted OR 0.44, 95% CI 0.30 to 0.64). General physical and mental health scores were similar across treatment groups, but poorest in men who had androgen deprivation therapy.
The various treatments for localised prostate cancer each have persistent effects on quality of life. Sexual dysfunction three years after diagnosis was common in all treatment groups, whereas poor urinary function was less common. Bowel function was most compromised in those who had external beam radiotherapy. Men with prostate cancer and the clinicians who treat them should be aware of the effects of treatment on quality of life, and weigh them up against the patient's age and the risk of progression of prostate cancer if untreated to make informed decisions about treatment.
量化局限性前列腺癌治疗对长期生活质量产生负面影响的风险及严重程度。
基于人群的前瞻性队列研究，随访三年。
澳大利亚新南威尔士州。
年龄小于70岁、于2000年10月至2002年10月期间确诊并被通知至新南威尔士州中央癌症登记处的局限性前列腺癌男性患者。对照者从新南威尔士州选民名册中随机选取，并按年龄和邮政编码与病例进行匹配。
根据12项简短健康调查问卷和加利福尼亚大学洛杉矶分校前列腺癌指数，在确诊后长达三年的时间里评估总体健康状况、特定健康功能及疾病特定功能。
1642例（64%）病例以及495例符合条件且被联系上的对照者参与了研究。在对混杂因素进行调整后，所有积极治疗组性功能优于对照组的几率均较低，尤其是接受雄激素剥夺治疗的男性（调整后的优势比（OR）为0.02，95%置信区间为0.01至0.07）。接受手术治疗的男性报告的排尿功能最差（调整后的OR为0.17，95%置信区间为0.13至0.22）。接受体外照射放疗的病例肠道功能最差（调整后的OR为0.44，95%置信区间为0.30至0.64）。各治疗组的总体身体和心理健康评分相似，但接受雄激素剥夺治疗的男性评分最差。
局限性前列腺癌的各种治疗方法均对生活质量有持续影响。确诊三年后性功能障碍在所有治疗组中都很常见，而排尿功能不佳则较少见。接受体外照射放疗的患者肠道功能受损最为严重。前列腺癌男性患者及其治疗临床医生应了解治疗对生活质量的影响，并将其与患者年龄以及不治疗时前列腺癌进展风险进行权衡，以便就治疗做出明智决策。
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