Dowrick Adam S, Wootten Addie C, Howard Nicholas, Peters Justin S, Murphy Declan G
Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.
BJU Int. 2016 Jul;118(1):60-7. doi: 10.1111/bju.13413. Epub 2016 Feb 23.
To investigate in a prospective, observational study whether transperineal prostate biopsy (TPbx) results in patient-reported quality-of-life (QoL) changes from baseline in the first 3-months after TPbx.
Consenting patients completed the 26-item Expanded Prostate cancer Index Composite (EPIC-26), the Sexual Health Inventory for Men, the International Prostate Symptom Score, the Generalised Anxiety Disorder seven-item scale, the Patient Health Questionnaire nine-item scale, and a global question about willingness to have a repeat TPbx in a years' time. The instruments were scored using published scoring methods. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to investigate statistically significant differences. Clinically significant differences were also investigated defined by published minimal important differences for the EPIC-26 and changes in established categorical groups for the other instruments.
In all, 53 patients consented to participate and completed the baseline questionnaire, in addition to at least one of the 1- or 3-month follow-up questionnaires. We found that most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, 24% had clinically worse urinary function and 18% had worse sexual function at 1 month. At 3 months, 3% of patients had clinically worse urinary function and 25% continued to have worse sexual function compared with baseline. Patients who were subsequently diagnosed with cancer based on the results of the TPbx, had statistically significantly reduced QoL for the EPIC-26 urinary scales and reduced improvements in scores on the psychological scales at the 1-month follow-up compared with those who were not diagnosed with cancer.
Most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, patients should be advised that a quarter may have clinically worse urinary function and nearly 20% have clinically worse sexual function in the first month, and that sexual function deficits may continue up to 3 months. The results of this study provide a resource that the clinician can use when discussing TPbx with patients.
在一项前瞻性观察性研究中，调查经会阴前列腺穿刺活检（TPbx）是否会导致患者报告的生活质量（QoL）在TPbx后的前3个月内相对于基线水平发生变化。
同意参与的患者完成了26项扩展前列腺癌指数综合量表（EPIC - 26）、男性性健康量表、国际前列腺症状评分、广泛性焦虑障碍七项量表、患者健康问卷九项量表，以及一个关于是否愿意在一年后再次进行TPbx的总体问题。这些量表使用已发表的评分方法进行评分。采用Wilcoxon符号秩检验和Mann - Whitney U检验来研究统计学上的显著差异。还根据已发表的EPIC - 26最小重要差异以及其他量表既定分类组的变化来研究临床显著差异。
共有53名患者同意参与并完成了基线问卷，以及至少一份1个月或3个月的随访问卷。我们发现，大多数接受TPbx的患者在TPbx后的前3个月内生活质量没有临床显著变化。然而，24%的患者在1个月时出现临床尿功能恶化，18%的患者性功能恶化。在3个月时，与基线相比，3%的患者临床尿功能恶化，25% 的患者性功能持续恶化。根据TPbx结果随后被诊断为癌症的患者，与未被诊断为癌症的患者相比，在1个月随访时，EPIC - 26尿量表的生活质量在统计学上显著降低，心理量表得分的改善也减少。
大多数接受TPbx的患者在TPbx后的前3个月内生活质量没有临床显著变化。然而，应告知患者，四分之一的患者可能在第一个月出现临床尿功能恶化，近20% 的患者临床性功能恶化，并且性功能缺陷可能持续长达3个月。本研究结果为临床医生在与患者讨论TPbx时提供了参考依据。
