1 Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands .
J Endourol. 2014 Jan;28(1):117-24. doi: 10.1089/end.2013.0349. Epub 2013 Sep 27.
To investigate the quality of life (QoL) after different treatment modalities for low-risk prostate cancer, including brachytherapy, robot-assisted laparoscopic prostatectomy (RALP), and active surveillance (AS) with validated questionnaires.
From a prospective database, we selected a total of 144 men with low-grade localized prostate cancer including 65 (45.1%) patients with RALP, 29 (20.2%) with brachytherapy, and 50 (34.7%) whose cancer was managed with AS. QoL was routinely evaluated with validated questionnaires: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30), EORTC-QLQ-Prostate Module (PR)25, International Index of Erectile Function (IIEF)-15, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with a minimum follow-up of 1 year.
In comparison with baseline scores, the brachytherapy group showed a significant decrease of QoL domain scores of voiding complaints (P=0.010), use of incontinence aids (P=0.011), sexual functioning domain (P=0.011), and erectile function (P≤0.001). In the RALP group, sexual function (P≤0.001), incontinence (P≤0.001), and erectile function were significantly affected. A decrease in sexual function was observed in 71% of men after RALP and 59% after brachytherapy. In 30% of men under AS, a decrease of erectile function score during follow-up was reported. Overall, no significant decrease in general QoL was observed neither for men under AS nor for men treated by brachytherapy or RALP. Clinical factors such as age, prostate size, prostate-specific antigen level, and nerve preservation during RALP were nonpredictive of overall QoL after treatment for the individual patient (P=0.676).
Patients with low-risk prostate cancer who are treated with brachytherapy or RALP report deterioration of QoL of specific domains such as voiding, continence, and sexual functioning in comparison with AS patients. A decrease of erectile function was also observed during AS. Overall QoL was similar for all three treatments options.
使用经过验证的问卷，研究低危前列腺癌患者接受不同治疗方式（包括近距离放射治疗、机器人辅助腹腔镜前列腺切除术[RALP]和主动监测[AS]）后的生活质量（QoL）。
我们从一个前瞻性数据库中选择了总共 144 名患有低级别局限性前列腺癌的男性患者，其中 65 名（45.1%）接受了 RALP 治疗，29 名（20.2%）接受了近距离放射治疗，50 名（34.7%）的癌症通过 AS 进行管理。使用经过验证的问卷常规评估 QoL：欧洲癌症研究与治疗组织生活质量问卷核心 30 项（EORTC-QLQ-C30）、EORTC-QLQ-Prostate 模块（PR）25、国际勃起功能指数（IIEF）-15、国际尿失禁咨询问卷简表（ICIQ-SF），随访时间至少为 1 年。
与基线评分相比，近距离放射治疗组在排尿症状（P=0.010）、使用失禁辅助器具（P=0.011）、性功能领域（P=0.011）和勃起功能（P≤0.001）方面的 QoL 域评分显著下降。在 RALP 组中，性功能（P≤0.001）、尿失禁（P≤0.001）和勃起功能受到显著影响。RALP 后 71%的男性和近距离放射治疗后 59%的男性性功能下降。在接受 AS 治疗的 30%的男性中，报告在随访期间勃起功能评分下降。总体而言，接受 AS 治疗或近距离放射治疗或 RALP 治疗的男性的总体 QoL 均无显著下降。年龄、前列腺大小、前列腺特异性抗原水平和 RALP 期间的神经保留等临床因素对个体患者治疗后的总体 QoL 无预测作用（P=0.676）。
与 AS 患者相比，接受近距离放射治疗或 RALP 治疗的低危前列腺癌患者在排尿、控尿和性功能等特定领域的 QoL 恶化。在 AS 期间也观察到勃起功能下降。所有三种治疗选择的总体 QoL 相似。
