Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Strasse 44, Magdeburg, D-39120, Germany.
BMC Med Inform Decis Mak. 2013 Aug 5;13:83. doi: 10.1186/1472-6947-13-83.
Patients with prostate cancer face the difficult decision between a wide range of therapeutic options. These men require elaborate information about their individual risk profile and the therapeutic strategies´ risks and benefits to choose the best possible option. In order to detect time trends and quality improvements between an early patient population (2003/2004) and a later reference group (2007/2008) data was analysed with regards to epidemiologic parameters, differences in diagnostics and the type and ranking of the recommended therapies taking into account changes to Gleason Grading System and implementation of new therapeutic strategies, particularly Active surveillance, in 2005.
Data from all 496 consecutive patients who received consultation in 2003/2004 (n = 280) and 2007/2008 (n = 216) was retrospectively evaluated. Categorical variables were compared using the Chi-square test. Dependent variables were analysed using the unpaired Students´ t-test and the Mann-Whitney U-test.
The cohorts were comparable concerning clinical stage, initial PSA, prostate volume, comorbidities and organ confined disease. Patients in Cohort I were younger (66.44 vs. 69.31y; p < .001) and had a longer life expectancy (17.22 vs. 14.75y; p < .001). 50.9%, 28.2% and 20.9% in Cohort I and 37.2%, 39.6% and 23.2% in Cohort II showed low-, intermediate- and high-risk disease (D´Amico) with a trend towards an increased risk profile in Cohort II (p = .066). The risk-adapted therapy recommended as first option was radical prostatectomy for 91.5% in Cohort I and 69.7% in Cohort II, radiation therapy for 83.7% in Cohort I and 50.7% in Cohort II, and other therapies (brachytherapy, Active surveillance, Watchful waiting, high-intensity focused ultrasound) for 6.5% in Cohort I and 6.9% in Cohort II (p < .001). Radiation therapy was predominant in both cohorts as second treatment option (p < .001). Time trends showing quality improvement involved an increase in biopsy cores (9.95 ± 2.38 vs. 8.43 ± 2.29; p < .001) and an increased recommendation for bilateral nerve sparing (p < .001).
In the earlier years, younger patients with a more favourable risk profile presented for interdisciplinary consultation. A unilateral recommendation for radical prostatectomy and radiation therapy was predominant. In the later years, the patient population was considerably older. However, this group may have benefitted from optimised diagnostic possibilities and a wider range of treatment options.
前列腺癌患者面临着广泛治疗选择的艰难决策。这些患者需要详细了解自己的个体风险状况以及治疗策略的风险和益处，以选择最佳的治疗方案。为了检测时间趋势和质量改进，我们分析了 2003/2004 年早期患者人群（n=280）和 2007/2008 年参考组（n=216）的数据，考虑到格里森分级系统的变化和新治疗策略的实施，特别是 2005 年开始的主动监测，这些数据与流行病学参数、诊断差异以及推荐治疗的类型和排名有关。
回顾性分析了 2003/2004 年（n=280）和 2007/2008 年（n=216）连续 496 例接受咨询的患者的数据。使用卡方检验比较分类变量。使用配对学生 t 检验和曼-惠特尼 U 检验分析因变量。
两组在临床分期、初始 PSA、前列腺体积、合并症和器官局限性疾病方面具有可比性。队列 I 中的患者更年轻（66.44 岁比 69.31 岁；p<.001），预期寿命更长（17.22 年比 14.75 年；p<.001）。队列 I 中有 50.9%、28.2%和 20.9%，队列 II 中有 37.2%、39.6%和 23.2%为低危、中危和高危疾病（D'Amico），队列 II 中的风险状况呈上升趋势（p=.066）。作为首选的风险适应治疗方法，队列 I 中为根治性前列腺切除术 91.5%，队列 II 中为 69.7%，队列 I 中为放射治疗 83.7%，队列 II 中为 50.7%，队列 I 中为其他治疗方法（近距离放射治疗、主动监测、观察等待、高强度聚焦超声）为 6.5%，队列 II 中为 6.9%（p<.001）。放射治疗在两个队列中都是第二治疗选择（p<.001）。质量改进的时间趋势涉及活检芯数量的增加（9.95±2.38 比 8.43±2.29；p<.001）和双侧神经保留推荐的增加（p<.001）。
在早期，具有更有利风险状况的年轻患者接受了跨学科咨询。单侧推荐根治性前列腺切除术和放射治疗占主导地位。在后期，患者群体明显更年长。然而，这一群体可能受益于优化的诊断可能性和更广泛的治疗选择。
