Virginia Mason, Seattle, Washington.
Center for Prostate Disease Research, Department of Defense, Rockville, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
J Urol. 2016 Aug;196(2):392-8. doi: 10.1016/j.juro.2016.02.2972. Epub 2016 Mar 11.
Active surveillance is an important alternative to definitive therapy for men with low risk prostate cancer. However, the impact of active surveillance on health related quality of life compared to that in men without cancer remains unknown. In this study we evaluated health related quality of life outcomes in men on active surveillance compared to men followed after negative prostate needle biopsy.
A prospective study was conducted on men who were enrolled into the Center for Prostate Disease Research Multicenter National Database and underwent prostate needle biopsy for suspicion of prostate cancer between 2007 and 2014. Health related quality of life was assessed at biopsy (baseline) and annually for up to 3 years using SF-36 and EPIC questionnaires. Health related quality of life scores were modeled using generalized estimating equations, adjusting for baseline health related quality of life, and demographic and clinical characteristics.
Of the 1,204 men who met the initial eligibility criteria 420 had a negative prostate needle biopsy (noncancer comparison group). Among the 411 men diagnosed with low risk prostate cancer 89 were on active surveillance. Longitudinal analysis revealed that for most health related quality of life subscales there were no significant differences between the groups in adjusted health related quality of life score trends over time.
In this study most health related quality of life outcomes in patients with low risk prostate cancer on active surveillance did not differ significantly from those of men without prostate cancer. A comparison group of men with a similar risk of prostate cancer detection is critical to clarify the psychological and physical impact of active surveillance.
主动监测是低危前列腺癌患者除明确治疗外的重要选择。然而，主动监测对健康相关生活质量的影响与无癌症男性相比尚不清楚。在这项研究中，我们评估了接受主动监测的男性与接受前列腺穿刺活检后随访的男性的健康相关生活质量结果。
前瞻性研究纳入了 2007 年至 2014 年间因疑似前列腺癌而接受前列腺穿刺活检的参加前列腺疾病研究中心多中心国家数据库的男性。使用 SF-36 和 EPIC 问卷在活检时（基线）和每年进行健康相关生活质量评估，最长达 3 年。使用广义估计方程对健康相关生活质量评分进行建模，调整基线健康相关生活质量以及人口统计学和临床特征。
在符合初始入选标准的 1204 名男性中，有 420 名男性进行了阴性前列腺穿刺活检（非癌症对照组）。在 411 名被诊断为低危前列腺癌的男性中，有 89 名接受了主动监测。纵向分析显示，对于大多数健康相关生活质量子量表，在调整后的健康相关生活质量评分趋势方面，两组之间在时间上没有显著差异。
在这项研究中，接受主动监测的低危前列腺癌患者的大多数健康相关生活质量结果与无前列腺癌男性无显著差异。与具有相似前列腺癌检出风险的对照组进行比较对于明确主动监测的心理和生理影响至关重要。
