Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN 37203, USA.
N Engl J Med. 2013 Jan 31;368(5):436-45. doi: 10.1056/NEJMoa1209978.
The purpose of this analysis was to compare long-term urinary, bowel, and sexual function after radical prostatectomy or external-beam radiation therapy.
The Prostate Cancer Outcomes Study (PCOS) enrolled 3533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1655 men in whom localized prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. We used multivariable propensity scoring to compare functional outcomes according to treatment.
Patients undergoing prostatectomy were more likely to have urinary incontinence than were those undergoing radiotherapy at 2 years (odds ratio, 6.22; 95% confidence interval [CI], 1.92 to 20.29) and 5 years (odds ratio, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference in the odds of urinary incontinence was noted at 15 years. Similarly, although patients undergoing prostatectomy were more likely to have erectile dysfunction at 2 years (odds ratio, 3.46; 95% CI, 1.93 to 6.17) and 5 years (odds ratio, 1.96; 95% CI, 1.05 to 3.63), no significant between-group difference was noted at 15 years. Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (odds ratio, 0.39; 95% CI, 0.22 to 0.68) and 5 years (odds ratio, 0.47; 95% CI, 0.26 to 0.84), again with no significant between-group difference in the odds of bowel urgency at 15 years.
At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. (Funded by the National Cancer Institute.).
本分析旨在比较根治性前列腺切除术或外照射放疗后长期的泌尿、肠道和性功能。
前列腺癌结局研究（PCOS）纳入了 1994 年或 1995 年诊断为前列腺癌的 3533 名男性。当前队列包括 1655 名年龄在 55 至 74 岁之间被诊断为局限性前列腺癌的男性，他们接受了手术（1164 名）或放疗（491 名）。功能状态在诊断后 2、5 和 15 年进行评估。我们使用多变量倾向评分来比较根据治疗的功能结果。
前列腺切除术患者在 2 年（优势比，6.22；95%置信区间[CI]，1.92 至 20.29）和 5 年（优势比，5.10；95%CI，2.29 至 11.36）时发生尿失禁的可能性大于放疗。然而，在 15 年时，两组之间尿失禁的几率没有显著差异。同样，虽然前列腺切除术患者在 2 年（优势比，3.46；95%CI，1.93 至 6.17）和 5 年（优势比，1.96；95%CI，1.05 至 3.63）时发生勃起功能障碍的可能性更大，但在 15 年时两组之间没有显著差异。前列腺切除术患者在 2 年（优势比，0.39；95%CI，0.22 至 0.68）和 5 年（优势比，0.47；95%CI，0.26 至 0.84）时发生肠道急迫的可能性较小，但在 15 年时两组之间肠道急迫的几率没有显著差异。
在 15 年时，接受前列腺切除术或放疗的男性在特定于疾病的功能结果方面没有显著的相对差异。尽管如此，在 15 年的随访中，接受局限性前列腺癌治疗的男性在所有功能领域均普遍出现下降。（由美国国家癌症研究所资助）。
