Storås Anne Holck, Sanda Martin G, Ferrer Montse, Loge Jon Håvard, Dahl Alv A, Steinsvik Eivind A S, Guedea Ferran, Cvancarova Milada, Fosså Sophie D
Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
Department of Urology, Emory University Hospital, Atlanta, GA.
Clin Genitourin Cancer. 2014 Aug;12(4):e117-25. doi: 10.1016/j.clgc.2013.12.007. Epub 2014 Jan 3.
In men with PCa, large variations of PROs after RP or high-dose RAD might be related to between-country differences of medical and sociodemographic variables, and differences in PROs before treatment in the sexual and urinary domains.
In 1908 patients with localized PCa from Norway, the United States, or Spain, the relation between medical (prostate-specific antigen, Gleason score, cT-category) and sociodemographic variables (age, education, marital status) before treatment was investigated. Using the Expanded Prostate Cancer Index Composite questionnaire, PROs before treatment within the sexual and urinary domains were also considered.
Compared with the European patients, American patients were younger, fewer had comorbid conditions, and more had a high education level. Fifty-three percent of the US men eligible for RP had low-risk tumors compared with 42% and 31% among the Norwegian and the Spanish patients, respectively. Among the Spanish RAD patients, 54% had had low-risk tumors compared with 34% of the American and 21% of the Norwegian men planned for RAD, respectively. Compared with the European patients, significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups, the number of patients with sexual or urinary dysfunction exceeded that of patients with bother related to the reported dysfunction.
Statistically significant between-country differences were observed in medical and sociodemographic variables, and in PROs before treatment within the sexual and urinary domains. Large differences between reported dysfunction and related problems within the sexual and urinary domains indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, might in part explain the large variation of side effects after treatment evident in the medical literature.
在前列腺癌男性患者中，根治性前列腺切除术（RP）或高剂量放疗（RAD）后患者报告结局（PROs）的巨大差异可能与国家间医学和社会人口统计学变量的差异，以及治疗前性和泌尿领域PROs的差异有关。
对来自挪威、美国或西班牙的1908例局限性前列腺癌患者，研究了治疗前医学变量（前列腺特异性抗原、Gleason评分、cT分期）与社会人口统计学变量（年龄、教育程度、婚姻状况）之间的关系。使用扩展前列腺癌指数综合问卷，还考虑了治疗前性和泌尿领域的PROs。
与欧洲患者相比，美国患者更年轻，合并症更少，受教育程度更高。符合RP条件的美国男性中53%患有低风险肿瘤，而挪威和西班牙患者中这一比例分别为42%和31%。在西班牙接受RAD治疗的患者中，54%患有低风险肿瘤，而计划接受RAD治疗的美国男性和挪威男性中这一比例分别为34%和21%。与欧洲患者相比，报告中度或重度性功能障碍及相关问题的美国患者明显更少。在大多数亚组中，性功能或泌尿功能障碍患者的数量超过了因报告的功能障碍而感到困扰的患者数量。
在医学和社会人口统计学变量以及治疗前性和泌尿领域的PROs方面观察到了具有统计学意义的国家间差异。性和泌尿领域报告的功能障碍与相关问题之间的巨大差异表明，除了计算汇总评分外，功能障碍和困扰应分别报告。记录在案的差异，至少在PROs方面，可能部分解释了医学文献中明显的治疗后副作用的巨大差异。
