Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Ruprecht-Karls University of Heidelberg, Medical Faculty, Heidelberg, Germany.
World J Urol. 2017 Dec;35(12):1841-1847. doi: 10.1007/s00345-017-2081-x. Epub 2017 Aug 31.
To investigate the influence of different postoperative radiotherapy (RT) regimes on post-prostatectomy continence and QoL.
Men after prostatectomy (RP) and RT were assigned in adjuvant (ART), early salvage (ESRT) and salvage radiotherapy (SRT) groups depending on time of initiation, indication and pre-RT-PSA (≤/>0.5 ng/ml). Continence and QoL outcomes were evaluated by validated questionnaire. Statistical analysis included students t test, Chi square, Fisher's test, ROC- and McNemar-Bowker-Analyses.
The mean follow-up was 5.1 years. 33.5, 38.2 and 28.3% received ART, ESRT and SRT, respectively. Mean time to RT was 0.3 (±0.4), 1.8 (±2.5) and 3.3 (±3.6) years respectively. Differences in age at RP (p = 0.54) and RT (p = 0.47) between groups were not significant. Mean-RT-dose was similar (p = 0.70). Differences in continence distribution between groups before (p = 0.56) and after RT (p = 0.38) were not significant. No significant differences were observed for frequency (p = 0.58) or amount (p = 0.88) of urine loss, impact on QoL (p = 0.13) and ICIQ-SF scores (p = 0.69) between groups. Even though no significant difference in post-RT-continence (p = 0.89) was observed in the direct comparison between groups, a significant worsening of long-term continence was observed in all groups (p < 0.001). We found no cutoff and no time-point after RP at which this negative effect of RT on continence became insignificant (AUC = 0.474). A subgroup with apparent local recurrence showed no differences for ICIQ-SF-score (p = 0.155), QoL (0.077), incontinence grade (p = 0.387), frequency (p = 0.182) and amount (p = 0.415) of urine loss. Proportionally more men in this subgroup remembered deterioration of continence after RT (p = 0.029).
Postoperative RT adversely affects long-term continence; this negative effect is irrespective of time of initiation or indication for RT. These results suggest a need for innovative strategies of prostate cancer therapy with lasting oncological, functional and QoL outcomes.
探讨不同术后放疗（RT）方案对前列腺切除术后控尿和生活质量（QoL）的影响。
根据启动时间、适应证和放疗前 PSA（≤/＞0.5ng/ml）将前列腺切除术后接受 RT 的患者分配至辅助放疗（ART）、早期挽救性放疗（ESRT）和挽救性放疗（SRT）组。通过验证后的问卷评估控尿和 QoL 结果。统计分析包括学生 t 检验、卡方检验、Fisher 检验、ROC 和 McNemar-Bowker 分析。
中位随访时间为 5.1 年。分别有 33.5%、38.2%和 28.3%的患者接受了 ART、ESRT 和 SRT。RT 开始的中位时间分别为 0.3（±0.4）、1.8（±2.5）和 3.3（±3.6）年。各组间 RP 时的年龄（p=0.54）和 RT 时的年龄（p=0.47）差异无统计学意义。平均 RT 剂量相似（p=0.70）。组间放疗前（p=0.56）和放疗后（p=0.38）的控尿分布差异无统计学意义。尿失禁频率（p=0.58）或量（p=0.88）、对 QoL 的影响（p=0.13）和 ICIQ-SF 评分（p=0.69）差异无统计学意义。尽管组间直接比较无 RT 后控尿的显著差异（p=0.89），但所有组的长期控尿均显著恶化（p＜0.001）。我们未发现 RP 后可确定的时间点或 RT 对控尿无显著影响的截止值（AUC=0.474）。在局部复发明显的亚组中，ICIQ-SF 评分（p=0.155）、QoL（0.077）、尿失禁程度（p=0.387）、频率（p=0.182）和量（p=0.415）差异均无统计学意义。该亚组中更多的男性在 RT 后回忆起控尿恶化（p=0.029）。
术后 RT 会对长期控尿产生不利影响；这种负面影响与 RT 的启动时间或适应证无关。这些结果表明需要采用创新的前列腺癌治疗策略，以获得持久的肿瘤学、功能和 QoL 结果。
