Loeb Stacy, Curnyn Caitlin, Walter Dawn, Fagerlin Angela, Siebert Uwe, Mühlberger Nick, Braithwaite R Scott, Schwartz Mark D, Lepor Herbert, Sedlander Erica
Department of Urology, New York University, NY, USA.
Population Health, New York University, NY, USA.
Transl Androl Urol. 2018 Apr;7(2):197-202. doi: 10.21037/tau.2017.03.80.
Active surveillance (AS) is the most rapidly expanding management option for favorable-risk prostate cancer (PCa). Early studies suggested substantial decrements in utility (quality of life weights) from disease-related anxiety. Our objective was to determine utilities for contemporary AS patients using different instruments.
We performed a systematic review of PubMed, PMC and OVID for utility measurements in modern AS patients. We then examined utilities among 37 men on AS participating in focus groups between 2015-2016 using the generic EurQol five dimensions questionnaire (EQ-5D-3L) and Patient Oriented Prostate Utility Scale (PORPUS), a PCa-specific instrument.
The systematic review found previous studies with utilities for PCa treatment and historical watchful waiting populations, but none specifically in contemporary AS. In our AS population, the mean EQ-5D-3L score was 0.90±0.16 (median, 1.00; range, 0.21-1.00) and PORPUS was 0.98±0.03 (median, 0.99; range, 0.84-1.00). The Spearman correlation between the EQ-5D-3L and PORPUS was 0.87 (P<0.0001), and 38% of patients had a difference >0.1 between instruments.
Most contemporary AS patients had high utility scores suggesting that they perceive themselves in good health without a major decrement in quality of life from the disease. However, some patients had substantial differences in utility measured with generic versus disease-specific instruments. Further study is warranted into the optimal instrument for utility assessment in contemporary AS patients.
主动监测（AS）是低危前列腺癌（PCa）最迅速扩展的管理选项。早期研究表明疾病相关焦虑会使效用（生活质量权重）大幅下降。我们的目标是使用不同工具确定当代AS患者的效用。
我们对PubMed、PMC和OVID进行了系统回顾，以获取现代AS患者的效用测量值。然后，我们使用通用的欧洲五维健康量表（EQ-5D-3L）和前列腺特异的患者导向前列腺效用量表（PORPUS），对2015年至2016年参加焦点小组的37名接受AS的男性的效用进行了检查。
系统回顾发现了以前关于PCa治疗效用和历史观察等待人群的研究，但没有专门针对当代AS患者的研究。在我们的AS人群中，EQ-5D-3L的平均得分为0.90±0.16（中位数为1.00；范围为0.21-1.00），PORPUS为0.98±0.03（中位数为0.99；范围为0.84-1.00）。EQ-5D-3L与PORPUS之间的Spearman相关性为0.87（P<0.0001），38%的患者在两种工具之间的差异>0.1。
大多数当代AS患者的效用得分较高，表明他们认为自己健康状况良好，疾病并未导致生活质量大幅下降。然而，一些患者在使用通用工具与疾病特异工具测量的效用方面存在显著差异。有必要进一步研究当代AS患者效用评估的最佳工具。
