Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
J Sex Med. 2012 Nov;9(11):2961-9. doi: 10.1111/j.1743-6109.2012.02806.x. Epub 2012 Jun 6.
Many patients diagnosed with localized prostate cancer (PCa) are presented with several treatment modalities, which may require time to understand these options before making an informed decision regarding treatment.
The aim of this study was to compare the effect of radical prostatectomy (RP) delay on postoperative functional outcomes and mortality in a North American population-based cohort.
Overall, 17,153 men treated with RP for non-metastatic clinical stage T1-2, low-grade PCa between years 1995 and 2005 within the U.S. Surveillance, Epidemiology, and End Results Medicare-linked database were abstracted.
The effect of treatment delay (from PCa diagnosis to RP of >3 months) on pathological upstaging at surgery (≥pT3) and postoperative functional outcomes (urinary incontinence and erectile dysfunction) was examined using logistic regression analyses. The 10-year PCa mortality rates were computed using cumulative incidence rates.
Overall, 2,576 (15%) patients underwent RP > 3 months after diagnosis. A treatment delay of >3 months was associated with a 24% and 33% higher rate of erectile dysfunction diagnosis and procedure, respectively (both P ≤ 0.001). Treatment delay was also associated with 6% higher rate of urinary incontinence procedure (P = 0.01). Furthermore, a dose-response effect was detected with respect to increasing durations of RP delay (≤3 vs. 3-5 vs. 5-9 vs. ≥9 months) the rates of erectile dysfunction and urinary incontinence diagnoses/procedures. Treatment delay was not associated with pathological upstaging and PCa mortality.
Customarily, the timing of RP following biopsy is dictated by tumor aggressiveness. In general, patients with more unfavorable characteristics are operated sooner. This may obliterate the potential detriments of delayed RP. The treatment delay between biopsy and RP may result in more extensive periprostatic tissue resection and may adversely affect postoperative continence and erectile function.
许多被诊断为局限性前列腺癌（PCa）的患者有多种治疗方法可供选择，在做出治疗决策之前，他们可能需要时间来了解这些选择。
本研究旨在比较北美人群队列中根治性前列腺切除术（RP）延迟对术后功能结局和死亡率的影响。
在美国监测、流行病学和最终结果医疗保险相关数据库中，1995 年至 2005 年间，共纳入 17153 例接受 RP 治疗非转移性临床 T1-2 期、低分级 PCa 的患者。
采用逻辑回归分析，研究治疗延迟（从 PCa 诊断到 RP 超过 3 个月）对手术时病理升级（≥pT3）和术后功能结局（尿失禁和勃起功能障碍）的影响。使用累积发生率计算 10 年 PCa 死亡率。
总体而言，2576 例（15%）患者在诊断后 3 个月以上接受 RP。治疗延迟超过 3 个月与勃起功能障碍诊断和手术的发生率分别增加 24%和 33%（均 P≤0.001）相关。治疗延迟与尿失禁手术的发生率增加 6%相关（P=0.01）。此外，随着 RP 延迟时间的增加（≤3 个月、3-5 个月、5-9 个月、≥9 个月），发现勃起功能障碍和尿失禁诊断/手术的发生率呈剂量反应关系。治疗延迟与病理升级和 PCa 死亡率无关。
通常情况下，RP 的时间取决于肿瘤的侵袭性。一般来说，具有更不利特征的患者会更早接受手术。这可能会消除 RP 延迟的潜在不利影响。活检和 RP 之间的治疗延迟可能导致更广泛的前列腺周围组织切除，并可能对术后控尿和勃起功能产生不利影响。
