Lehto Ulla-Sisko, Tenhola Heli, Taari Kimmo, Aromaa Arpo
National Institute for Health and Welfare THL, Health Monitoring Unit, Helsinki FI00271, Finland.
University of Helsinki, Division of Social Pharmacy; DRA Consulting Oy, Helsinki FI01510, Finland.
Br J Cancer. 2017 Mar 28;116(7):864-873. doi: 10.1038/bjc.2017.30. Epub 2017 Feb 21.
Although the prognosis of localised prostate cancer is good, the negative effects of prostate cancer treatment often impair patient quality of life. A growing number of men experience these negative effects over a longer time because of the increased incidence of and prolonged survival in prostate cancer, and the ageing of the population. Only a few studies have investigated the adverse effects of different prostate cancer treatments using large population-based samples.
We conducted a nationwide survey (n=1239) to collect detailed information regarding the negative effects (i.e., the occurrence, perceived level and perceived bother since the beginning of the treatment) of prostate cancer treatments: radical prostatectomy, external beam radiotherapy, brachytherapy, hormone therapy and surveillance. Furthermore, we measured patient satisfaction with the outcome of the treatment and their psychological well-being (i.e., psychological symptoms and satisfaction with life) 5 years after diagnosis. The negative effects between the treatments were compared, and the determinants of satisfaction and psychological well-being were investigated.
The negative effects of all types of active prostate cancer treatments were common and persistent (33-48% reported symptoms at 5 years) and showed the known differences between the treatments. Prostatectomy and the radiotherapies caused urinary leakage; radiotherapy also caused symptoms of urinary irritation; and external radiation also caused bowel dysfunction. Most symptoms were considered highly bothersome. Most respondents (81-93%) reported that their treatment negatively affected their sex lives; 70-92% reported sexual dysfunction; and 20-58% reported that their sex lives with their spouses had ended. Urinary symptoms were especially associated with poorer psychological outcomes. The perception of symptom level and bother had a greater effect on patient satisfaction and well-being than the symptoms per se.
Multiple and persistent negative effects follow active prostate cancer treatment, and these effects predict long-term patient satisfaction and psychological well-being. The harms and benefits associated with prostate cancer treatments should be considered when selecting whether and how to actively treat prostate cancer.
尽管局限性前列腺癌的预后良好，但前列腺癌治疗的负面影响往往会损害患者的生活质量。由于前列腺癌发病率上升、生存率延长以及人口老龄化，越来越多的男性在更长时间内经历这些负面影响。只有少数研究使用基于大样本人群的样本调查了不同前列腺癌治疗方法的不良反应。
我们进行了一项全国性调查（n = 1239），以收集有关前列腺癌治疗（根治性前列腺切除术、外照射放疗、近距离放疗、激素治疗和监测）的负面影响（即治疗开始后的发生情况、感知程度和困扰程度）的详细信息。此外，我们在诊断5年后测量了患者对治疗结果的满意度及其心理健康状况（即心理症状和生活满意度）。比较了不同治疗方法之间的负面影响，并调查了满意度和心理健康状况的决定因素。
所有类型的积极前列腺癌治疗的负面影响都很常见且持续存在（5年后33%-48%的患者报告有症状），并且显示出不同治疗方法之间已知的差异。前列腺切除术和放疗会导致尿失禁；放疗还会引起尿路刺激症状；外照射也会导致肠道功能障碍。大多数症状被认为非常困扰。大多数受访者（81%-93%）报告称他们的治疗对性生活有负面影响；70%-92%报告有性功能障碍；20%-58%报告他们与配偶的性生活已经结束。尿路症状尤其与较差的心理结果相关。症状程度和困扰程度的感知对患者满意度和幸福感的影响比症状本身更大。
积极的前列腺癌治疗会带来多种持续的负面影响，这些影响预示着患者的长期满意度和心理健康状况。在选择是否以及如何积极治疗前列腺癌时，应考虑与前列腺癌治疗相关的危害和益处。
