Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
J Urol. 2011 Nov;186(5):1862-7. doi: 10.1016/j.juro.2011.06.058. Epub 2011 Sep 23.
We examined patient reported outcomes among patients with prostate cancer treated with watchful waiting in a nationwide cohort.
We collected treatment information and patient reported outcomes from 1,230 patients with prostate cancer diagnosed with T1-T2 prostate cancer in the Physicians' Health Study, of whom 125 were initially treated with watchful waiting. Cox proportional hazards regression was used to identify predictors of treatment initiation among patients on watchful waiting. Logistic regression was used to calculate the OR and 95% CI to assess disease targeted quality of life by initial treatment or watchful waiting.
At a mean 7.3-year followup 41% of patients on watchful waiting remained free of treatment while 34% had received radiotherapy or brachytherapy, 16% had received primary hormonal therapy and 10% had undergone prostatectomy. Younger age, higher clinical stage, higher Gleason score and higher prostate specific antigen at diagnosis predicted progression to treatment. Watchful waiting compared to immediate treatment was associated with less urinary incontinence (3.5% vs 10%) and impotence (68% vs 78%) but more common obstructive urinary symptoms (22% vs 13%) on univariate analysis (each p <0.05). Incontinence and impotence differences remained significant after adjusting for age, comorbidity and time after cancer diagnosis. Quality of life outcomes in men who underwent delayed treatment after initially waiting were not worse than in men who underwent immediate treatment.
Findings suggest quality of life benefits after watchful waiting in select patients with early stage prostate cancer compared to men treated immediately after diagnosis. Younger age and greater cancer severity at diagnosis predicted progression to treatment.
我们研究了在全国性队列中接受观察等待治疗的前列腺癌患者的患者报告结局。
我们从医师健康研究中收集了 1230 名 T1-T2 期前列腺癌患者的治疗信息和患者报告结局，其中 125 名患者最初接受观察等待治疗。使用 Cox 比例风险回归确定观察等待患者开始治疗的预测因素。使用逻辑回归计算 OR 和 95%CI，以评估初始治疗或观察等待对疾病针对性生活质量的影响。
在平均 7.3 年的随访中，41%的观察等待患者仍未接受治疗，而 34%的患者接受了放疗或近距离放疗，16%的患者接受了原发性激素治疗，10%的患者接受了前列腺切除术。年龄较小、临床分期较高、Gleason 评分较高和诊断时前列腺特异性抗原较高与进展为治疗相关。与立即治疗相比，观察等待与较少的尿失禁（3.5%比 10%）和勃起功能障碍（68%比 78%）相关，但更常见的梗阻性尿症状（22%比 13%）（均 P<0.05）。在调整年龄、合并症和癌症诊断后时间后，尿失禁和勃起功能障碍的差异仍然显著。最初等待后延迟治疗的男性的生活质量结果并不比立即治疗的男性差。
研究结果表明，与诊断后立即治疗相比，在选择的早期前列腺癌患者中，观察等待具有更好的生活质量获益。年龄较小和诊断时癌症严重程度较高预测进展为治疗。
