Gavin Anna T, Donnelly David, Donnelly Conan, Drummond Frances J, Morgan Eileen, Gormley Gerard J, Sharp Linda
N. Ireland Cancer Registry; Queen's University Belfast, Centre for Public Health, Belfast, N. Ireland.
Department of Epidemiology and Public Health, School of Nursing and Midwifery, University College Cork, Cork, Ireland.
BMJ Open. 2016 Dec 19;6(12):e012952. doi: 10.1136/bmjopen-2016-012952.
To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations.
PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI).
A cross-sectional postal questionnaire was sent to PCa survivors 2-18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into 'late disease' (stage III/IV and any Gleason grade (GG) at diagnosis) and 'early disease' (stage I/II and GG 2-7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression.
3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score.
Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.
调查在相似人群中提高前列腺癌（PCa）检查和治疗水平对男性健康和幸福的影响。
爱尔兰的PCa幸存者，其中爱尔兰共和国（RoI）的PCa发病率比北爱尔兰（NI）高50%。
向治疗后2至18年的PCa幸存者发送一份横断面邮政调查问卷，询问有关治疗当前的身体影响、健康相关生活质量（HRQoL；欧洲癌症研究与治疗组织核心生活质量问卷C30；EQ-5D-5L）以及心理健康（抑郁、焦虑和压力量表21项版本，DASS-21）的信息。比较RoI和NI幸存者的结果，分为“晚期疾病”（诊断时为III/IV期且任何Gleason分级（GG））和“早期疾病”（I/II期且GG 2-7）。根据年龄、地区和诊断后的时间对回答进行加权。使用多变量逻辑回归和线性回归研究国家间差异。
3348名男性做出回应（RoI为2567名；NI为781名；反映了人口规模，回应率为54%）。RoI的回应者更年轻；合并症较少（45%对38%）；更有可能无症状就诊（66%；41%）或患有早期疾病（56%；35%）；目前接受雄激素剥夺治疗（ADT）的情况较少（2%；28%）。RoI和NI之间目前尿失禁（16%）和阳痿（早期疾病56%，晚期疾病67%）的患病率没有差异。在早期疾病中，多变量分析中仅当前肠道问题存在显著差异（RoI为12%；NI为21%）。在晚期疾病中，NI男性报告的男性乳房发育（23%对9%）和潮热（41%对19%）水平显著更高，但单独分析ADT使用者时，差异消失。对于HRQoL，在多变量分析中，国家间仅疼痛（早期疾病：RoI为11.1，NI为19.4）和经济困难（晚期疾病：RoI为10.4，NI为7.9）存在显著差异。DASS-21或指数ED-5D-5L评分在国家间没有显著差异。
普遍报告了治疗副作用，RoI中PCa检测增加使更多男性出现这些副作用。我们建议在进行充分知情讨论后再为男性提供PSA检测。
