Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands.
Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst; St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.
Diagn Interv Radiol. 2018 Sep;24(5):268-275. doi: 10.5152/dir.2018.17374.
We aimed to evaluate the genitourinary function and quality of life (QoL) following the ablation of different prostate segments with irreversible electroporation (IRE) for localized prostate cancer (PCa).
Sixty patients who received primary focal IRE for organ-confined PCa were recruited for this study. Patients were evaluated for genitourinary function and QoL per prostate segment treated (anterior vs. posterior, apex vs. base vs. apex-to-base, unilateral vs. bilateral). IRE system settings and patient characteristics were compared between patients with preserved vs. those with impaired erectile function and urinary continence. Data were prospectively collected at baseline, 3, 6, and 12 months using the expanded prostate cancer index composite, American Urological Association symptom score, SF-12 physical and mental component summary surveys. Difference over time within segments per questionnaire was evaluated using the Wilcoxon's signed rank test. Outcome differences between segments were assessed using covariance models. Baseline measurements included questionnaire scores, age, and prostate volume.
There were no statistically significant changes over time for overall urinary (P = 0.07-0.89), bowel (P = 0.06-0.79), physical (P = 0.18-0.71) and mental (P = 0.45-0.94) QoL scores within each segment. Deterioration of sexual function scores was observed at 6 months within each segment (P = 0.001-0.16). There were no statistically significant differences in QoL scores between prostate segments (P = 0.08-0.97). Older patients or those with poor baseline sexual function at time of treatment were associated with a greater risk of developing erectile dysfunction.
IRE is a feasible modality for all prostate segments without any significantly different effect on the QoL outcomes. Older patients and those with poor sexual function need to be counseled regarding the risk of erectile dysfunction.
我们旨在评估不同前列腺段采用不可逆电穿孔（IRE）消融治疗局限性前列腺癌（PCa）后的泌尿生殖功能和生活质量（QoL）。
本研究共纳入 60 例因局限性前列腺癌接受首次局灶性 IRE 治疗的患者。根据治疗的前列腺段（前叶 vs. 后叶，尖部 vs. 基底部 vs. 尖部-基底部，单侧 vs. 双侧）评估患者的泌尿生殖功能和 QoL。对保留和丧失勃起功能及尿控的患者，比较 IRE 系统设置和患者特征。使用扩展前列腺癌指数复合量表、美国泌尿外科学会症状评分、SF-12 身体和精神成分综合调查，在基线、3、6 和 12 个月时前瞻性收集数据。使用 Wilcoxon 符号秩检验评估每个问卷各时间段内各节段的差异。使用协方差模型评估各节段之间的结果差异。基线测量包括问卷评分、年龄和前列腺体积。
各节段的总体尿控（P = 0.07-0.89）、排便（P = 0.06-0.79）、躯体（P = 0.18-0.71）和精神（P = 0.45-0.94）QoL 评分在各时间段内均无统计学意义的变化。在各节段内，6 个月时观察到性功能评分恶化（P = 0.001-0.16）。各前列腺段的 QoL 评分无统计学差异（P = 0.08-0.97）。年龄较大的患者或治疗时基线性功能较差的患者发生勃起功能障碍的风险较高。
IRE 是一种可行的治疗所有前列腺段的方法，对 QoL 结果无明显影响。年龄较大的患者和性功能较差的患者需要告知勃起功能障碍的风险。
