Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
James Cook University, Cairns, Australia.
Cancer Treat Rev. 2018 May;66:23-44. doi: 10.1016/j.ctrv.2018.03.005. Epub 2018 Apr 3.
The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments.
We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747.
Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening.
No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
本系统评价旨在评估以患者报告的结局（PROs）衡量的局限性前列腺癌患者接受根治性治疗的影响，并探讨治疗方法内不同方法之间的差异。
我们按照 PRISMA 指南进行了 2005 年 1 月至 2017 年 3 月的系统文献检索，包括前瞻性测量局限性前列腺癌患者疾病特异性 PROs 的纵向研究，随访时间从治疗前到治疗后（≥1 年）。两位评审员独立提取数据并评估偏倚风险。该研究已在 PROSPERO 中注册：CRD42015019747。
在 148 项已确定的研究中，有 60 项被纳入荟萃分析。在第 1 年，根治性前列腺切除术患者的尿路刺激-梗阻症状有较小的改善（0.37SD，95%CI：0.30，0.45），但性功能和尿失禁恶化较大，具有较高的异质性（77%和 93%）。外放射治疗患者的性功能恶化中度（-0.46SD，95%CI：-0.55，-0.36），尿失禁（-0.16SD，95%CI：-0.23，-0.09）和肠功能障碍（-0.31SD，95%CI：-0.39，-0.23）。近距离放射治疗患者的尿失禁（-0.29SD，95%CI：-0.39，-0.19）、尿路刺激-梗阻症状（-0.35SD，95%CI：-0.47，-0.23）、性功能（-0.12SD，95%CI：-0.24，-0.002）和肠道不适（-0.27SD，95%CI：-0.42，-0.11）恶化较小。这些模式一直持续到第 5 年。高强度聚焦超声和主动监测仅在第 1 年有结果，没有统计学意义的恶化。
在每种治疗方法内，不同方法之间的 PRO 没有明显差异。目前，有证据支持近距离放射治疗作为根治性前列腺切除术的替代方法，适用于寻求尝试治愈性治疗以限制尿失禁和性功能障碍风险的患者。
