年龄对局限性前列腺癌治疗后生活质量结局的影响。
Impact of age on quality-of-life outcomes after treatment for localized prostate cancer.
机构信息
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Eur Urol. 2015 Sep;68(3):480-6. doi: 10.1016/j.eururo.2015.01.008. Epub 2015 Feb 2.
BACKGROUND
Men aged >65 yr are less likely to receive local therapy for prostate cancer (PCa), perhaps because of concerns about quality-of-life (QOL) outcomes.
OBJECTIVE
To describe QOL before and after PCa treatment in men of varying ages.
DESIGN, SETTING, AND PARTICIPANTS: Participants enrolled in CaPSURE who underwent radical prostatectomy, brachytherapy, external beam radiation, androgen deprivation therapy, or active surveillance for localized PCa.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
QOL changes over time were assessed among age groups using repeated-measures mixed models adjusted for race, year, clinical risk, treatment, comorbidities, and an age-time interaction term. Differences are reported as adjusted least-square means and percentage decline. Secondary analyses evaluated age and QOL for local (prostatectomy, radiation) compared to nonlocal treatment (hormonal, surveillance).
RESULTS AND LIMITATIONS
Older men had lower mean unadjusted pre- and post-treatment QOL scores for nearly all domains. Of the domains evaluated, adjusted mean sexual function, sexual bother, and urinary function showed greater declines from baseline to 2 yr. At 2 yr, more men <60 yr than those >70 yr experienced declines in urinary function (14% vs 9%) and sexual bother (39% vs 17%). Declines in these domains were also greater for local than for nonlocal treatment.
CONCLUSIONS
Definitive treatment for localized disease should not be deferred for older men because of fears regarding QOL declines. Younger men should be counseled about potential post-treatment declines in QOL despite higher absolute QOL scores. Communicating these differences to patients will facilitate more appropriate treatment decision-making in men of all ages.
PATIENT SUMMARY
In this study we evaluated quality of life before and after treatment for localized prostate cancer in a diverse patient population. Declines in quality of life after treatment varied according to age and treatment. We conclude that counseling about quality of life will help patients of all ages to make more appropriate treatment decisions.
背景
年龄 >65 岁的男性接受前列腺癌（PCa）局部治疗的可能性较低，这可能是由于对生活质量（QOL）结果的担忧。
目的
描述不同年龄男性 PCa 治疗前后的 QOL。
设计、地点和参与者：在接受根治性前列腺切除术、近距离放射治疗、外照射放射治疗、雄激素剥夺治疗或局部 PCa 主动监测的 CaPSURE 参与者中。
测量和统计分析
使用重复测量混合模型，根据种族、年份、临床风险、治疗、合并症和年龄-时间交互项，评估不同年龄组的 QOL 随时间的变化。报告差异作为调整后的最小二乘均值和百分比下降。次要分析评估了局部（前列腺切除术、放射治疗）与非局部（激素、监测）治疗的年龄和 QOL。
结果和局限性
年龄较大的男性在几乎所有领域的未调整预治疗和治疗后 QOL 评分均较低。在所评估的领域中，调整后的平均性功能、性困扰和尿功能从基线到 2 年的下降幅度最大。在 2 年时，与 >70 岁的男性相比，<60 岁的男性在尿功能（14%比 9%）和性困扰（39%比 17%）方面的下降更为明显。与非局部治疗相比，这些领域的下降也更大。
结论
不应因为担心 QOL 下降而推迟对老年男性进行局部疾病的确定性治疗。尽管绝对 QOL 评分较高，也应告知年轻男性治疗后 QOL 可能下降。向患者传达这些差异将有助于所有年龄段的男性做出更恰当的治疗决策。
患者总结
在这项研究中，我们评估了不同患者人群中局部前列腺癌治疗前后的生活质量。治疗后生活质量的下降因年龄和治疗而异。我们的结论是，关于生活质量的咨询将帮助所有年龄段的患者做出更恰当的治疗决策。
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