Sciarra Alessandro, Gentilucci Alessandro, Salciccia Stefano, Von Heland Magnus, Ricciuti Giam Piero, Marzio Vittorio, Pierella Federico, Musio Daniela, Tombolini Vincenzo, Frantellizzi Viviana, Pasquini Massimo, Maraone Annalisa, Guandalini Alessio, Maggi Martina
Department of Urological Sciences, University Sapienza, Rome, Italy.
Department of Radiotherapy, University Sapienza, Rome, Italy.
Urol Oncol. 2018 Jul;36(7):340.e7-340.e21. doi: 10.1016/j.urolonc.2018.03.022. Epub 2018 Apr 26.
The aim of the study was to comparatively evaluate the psychological and functional effect of different primary treatments in patients with prostate cancer.
We conducted a single-center prospective non randomized study in a real-life setting using functional and psychological questionnaires in prostate cancer cases submitted to radical prostatectomy, external radiotherapy, or active surveillance. Totally, 220 cases were evaluated at baseline and during the follow-up at 1-, 3-, 6-, and 12-month interval after therapy. Patients self-completed questionnaires on urinary symptoms and incontinence, erectile and bowel function, psychological distress (PD), anxiety, and depression.
Several significant differences among the three groups of treatment were found regarding the total score of the functional questionnaires. Regarding PD, cases submitted to radical prostatectomy showed stable scores during all the 12 months of follow-up whereas cases submitted to radiotherapy showed a rapid significant worsening of scores at 1-month interval and persistent also at 6- and 12-month interval. Cases submitted to active surveillance showed a slight and slow worsening of scores only at 12-month interval. PD and depression resulted to be more associated with urinary symptoms than sexual function worsening whereas anxiety resulted to be associated either with urinary symptoms or sexual function worsening.
The results of our comparative and prospective analysis could be used to better inform treatment decision-making. Patients and their teams might wish to know how functional and psychological aspects may differently be influenced by treatment choice.
本研究旨在比较评估不同初始治疗方法对前列腺癌患者心理和功能的影响。
我们在实际临床环境中开展了一项单中心前瞻性非随机研究，对接受根治性前列腺切除术、体外放疗或主动监测的前列腺癌患者使用功能和心理问卷进行评估。总共220例患者在基线时以及治疗后1个月、3个月、6个月和12个月随访期间接受评估。患者自行填写关于泌尿系统症状和尿失禁、勃起和肠道功能、心理困扰（PD）、焦虑和抑郁的问卷。
在功能问卷总分方面，三组治疗方法之间存在若干显著差异。关于心理困扰，接受根治性前列腺切除术的患者在12个月的随访期间评分稳定，而接受放疗的患者在1个月时评分迅速显著恶化，在6个月和12个月时仍持续恶化。接受主动监测的患者仅在12个月时评分有轻微且缓慢的恶化。心理困扰和抑郁与泌尿系统症状恶化的关联比与性功能恶化的关联更大，而焦虑与泌尿系统症状或性功能恶化均有关联。
我们的比较性前瞻性分析结果可用于更好地指导治疗决策。患者及其医疗团队可能希望了解治疗选择如何不同地影响功能和心理方面。
