Department of Urology, Leto Hospital, Athens, Greece.
Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK.
Eur Urol. 2017 Dec;72(6):869-885. doi: 10.1016/j.eururo.2017.06.035. Epub 2017 Jul 27.
Current evidence-based management for clinically localised prostate cancer includes active surveillance, surgery, external beam radiotherapy (EBRT) and brachytherapy. The impact of these treatment modalities on quality of life (QoL) is uncertain.
To systematically review comparative studies investigating disease-specific QoL outcomes as assessed by validated cancer-specific patient-reported outcome measures with at least 1 yr of follow-up after primary treatment for clinically localised prostate cancer.
MEDLINE, EMBASE, AMED, PsycINFO, and Cochrane Library were searched to identify relevant studies. Studies were critically appraised for the risk of bias. A narrative synthesis was undertaken.
Of 11486 articles identified, 18 studies were eligible for inclusion, including three randomised controlled trials (RCTs; follow-up range: 60-72 mo) and 15 nonrandomised comparative studies (follow-up range: 12-180 mo) recruiting a total of 13604 patients. Two RCTs recruited small cohorts and only one was judged to have a low risk of bias. The quality of evidence from observational studies was low to moderate. For a follow-up of up to 6 yr, active surveillance was found to have the lowest impact on cancer-specific QoL, surgery had a negative impact on urinary and sexual function when compared with active surveillance and EBRT, and EBRT had a negative impact on bowel function when compared with active surveillance and surgery. Data from one small RCT reported that brachytherapy has a negative impact on urinary function 1 yr post-treatment, but no significant urinary toxicity was reported at 5 yr.
This is the first systematic review comparing the impact of different primary treatments on cancer-specific QoL for men with clinically localised prostate cancer, using validated cancer-specific patient-reported outcome measures only. There is robust evidence that choice of primary treatment for localised prostate cancer has distinct impacts on patients' QoL. This should be discussed in detail with patients during pretreatment counselling.
Our review of the current evidence suggests that for a period of up to 6 yr after treatment, men with localised prostate cancer who were managed with active surveillance reported high levels of quality of life (QoL). Men treated with surgery reported mainly urinary and sexual problems, while those treated with external beam radiotherapy reported mainly bowel problems. Men eligible for brachytherapy reported urinary problems up to a year after therapy, but then their QoL returned gradually to as it was before treatment.
目前，临床局限性前列腺癌的循证医学管理包括主动监测、手术、外照射放疗（EBRT）和近距离放射治疗。这些治疗方法对生活质量（QoL）的影响尚不确定。
系统综述比较研究，评估临床局限性前列腺癌患者经主要治疗后至少 1 年的疾病特异性 QoL 结局，这些研究使用经过验证的癌症特异性患者报告结局测量工具。
对 MEDLINE、EMBASE、AMED、PsycINFO 和 Cochrane Library 进行检索，以确定相关研究。对研究进行了风险偏倚的严格评估。采用叙述性综合法进行分析。
在 11486 篇文章中，有 18 项研究符合纳入标准，包括 3 项随机对照试验（RCT；随访时间范围：60-72 个月）和 15 项非随机对照比较研究（随访时间范围：12-180 个月），共纳入 13604 例患者。两项 RCT 纳入的队列较小，仅有一项被认为低风险偏倚。来自观察性研究的证据质量为低到中。在随访时间不超过 6 年的情况下，主动监测对癌症特异性 QoL 的影响最低，与主动监测和 EBRT 相比，手术对尿功能和性功能有负面影响，与主动监测和手术相比，EBRT 对肠功能有负面影响。一项小型 RCT 的数据报告称，近距离放射治疗治疗后 1 年对尿功能有负面影响，但在 5 年后没有报告明显的尿毒性。
这是首次使用仅经过验证的癌症特异性患者报告结局测量工具，系统比较不同初始治疗方法对临床局限性前列腺癌患者癌症特异性 QoL 影响的综述。有确凿的证据表明，局部前列腺癌的初始治疗选择对患者的 QoL 有明显影响。在治疗前咨询中应与患者详细讨论。
我们对现有证据的综述表明，在治疗后长达 6 年的时间内，接受主动监测治疗的局限性前列腺癌男性报告了较高的生活质量（QoL）。接受手术治疗的男性报告主要存在尿功能和性功能问题，而接受外照射放疗的男性报告主要存在肠功能问题。有资格接受近距离放射治疗的男性在治疗后 1 年内报告有尿功能问题，但随后他们的 QoL 逐渐恢复到治疗前的水平。
