University of California San Francisco, San Francisco, CA, USA.
BJU Int. 2010 Oct;106(7):1022-9. doi: 10.1111/j.1464-410X.2010.09231.x. Epub 2010 Feb 23.
To quantitatively assess the effect of radical prostatectomy (RP) on the specific domains that comprise overall sexual function (SF), focusing on the relationships among these domains and overall SF, and to identify predictors for recovery of SF over time, as a decline in SF and sexual bother (SB) are known potential complications of treatment for prostate cancer.
Within the Cancer of the Prostate Strategic Urologic Research Endeavor database, we identified men diagnosed between 1995 and 2001 with localized prostate cancer treated with RP. SF and SB outcomes, measured using the University of California Los Angeles Prostate Cancer Index, were assessed at 6-month intervals for 4 years after RP.
In all, 620 men met the study criteria; at 6 months after RP, overall and all the specific domains of SF declined, with improvement in most specific domains by 2 years after RP. The greatest declines were in the ability to achieve erections, high-quality erections, and frequent erections; these domains were also most strongly correlated with overall SF. Sexual desire was relatively preserved, and there was a weak correlation between overall SF and sexual desire after RP, when there was the greatest discrepancy between sexual desire and other domains of function. SB showed continued improvement over time to 4 years but was not well correlated with any measurements of SF assessed. Younger age, college education, sexual aid and medication use, the absence of comorbid conditions, and nerve-sparing surgery were predictive of significant recovery of function in several specific domains of SF.
RP affects specific domains of SF to differing degrees. Compromised erectile function is most commonly reported among these specific domains and seems to play a more dominant role in determining overall SF, but notably none of the domains of function were closely linked to SB. Because education is protective in the perception of bother, appropriate counselling and the setting of expectations for outcomes in overall and specific domains of SF might lead to improved quality of life after treatment for prostate cancer.
定量评估根治性前列腺切除术 (RP) 对整体性功能 (SF) 特定领域的影响，重点关注这些领域与整体 SF 之间的关系，并确定随时间恢复 SF 的预测因素，因为 SF 下降和性困扰 (SB) 是前列腺癌治疗的已知潜在并发症。
在癌症前列腺战略泌尿科研究努力数据库中，我们确定了 1995 年至 2001 年间诊断为局限性前列腺癌并接受 RP 治疗的男性。使用加利福尼亚大学洛杉矶前列腺癌指数评估 SF 和 SB 结果，在 RP 后 4 年内每 6 个月评估一次。
共有 620 名男性符合研究标准；在 RP 后 6 个月，整体和 SF 的所有特定领域均下降，大多数特定领域在 RP 后 2 年得到改善。下降幅度最大的是勃起能力、高质量勃起和频繁勃起；这些领域也与整体 SF 相关性最强。性欲相对保留，RP 后性欲与其他功能领域之间存在最大差异时，SF 与性欲之间存在较弱的相关性。SB 在 4 年内持续改善，但与评估的任何 SF 测量均无良好相关性。年龄较小、大学教育、性辅助和药物使用、无合并症以及神经保留手术是 SF 几个特定领域功能显著恢复的预测因素。
RP 对 SF 的特定领域产生不同程度的影响。这些特定领域中最常见的是勃起功能受损，并且似乎在确定整体 SF 方面发挥更主导作用，但值得注意的是，功能的任何领域都与 SB 没有密切联系。由于教育在困扰的感知中具有保护作用，因此适当的咨询和设定对整体和 SF 特定领域结果的期望可能会提高前列腺癌治疗后的生活质量。
