Urology Department, Hospital del Mar-IMIM, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
Autonomous University of Barcelona, Barcelona, Spain.
Health Qual Life Outcomes. 2019 Jan 14;17(1):11. doi: 10.1186/s12955-019-1082-4.
The purpose of this study is to describe Health-Related Quality of Life (HRQoL) of localized prostate cancer patients in an Active Surveillance (AS) program, and to compare them with those undergoing radical prostatectomy (RP), external-beam radiotherapy (XRT) and brachytherapy (BT).
Multi-institutional pooled cross-sectional analysis on patients in an AS protocol: < 75 years old; pathologically confirmed LPC (maximum of three positive cylinders); Gleason score < 3 + 4; clinical stage T1a-T2b; and PSA < 15 ng/ml. Exclusion criteria for this study were: less than 6 months in AS, termination of AS protocol, or incomplete data. Patients in AS were matched with those treated with RP, XRT or BT from the 'Spanish Multicentric Study of Clinically Localized Prostate Cancer' cohort according to risk group, time from treatment selection to HRQoL survey, and age. Prostate-specific (EPIC) and generic (SF-36) HRQoL instruments were completed. Analysis was stratified by HRQoL survey moment (>or < 2.5 years from treatment selection), and age (>or < 70 years old).
Median of time from treatment selection to HRQoL survey in the total 396 patients (99 per treatment group) was 2.4 years (range 0.5-8.3). Patients in AS presented higher (better) urinary incontinence scores than RP ones in both stratus of time from treatment selection to HRQoL survey (92.6 vs 67.0 and 81.4 vs 64.4, p < 0.01). Patients in AS for < 2.5 years presented greater sexual scores than any active treatment (p < 0.01), but only statistically higher than RP for those in AS for longer than 2.5 years. The magnitude of the differences between AS and RP groups in both EPIC domains ranged from moderate (0.7 SD) to large (1.0 SD). Regardless of treatment applied, patients presented similar and slightly increased SF-36 scores than US general population reference norms. Nonetheless, patients in AS for < 2.5 years reported worse outcomes than other treatment groups on physical health domains, especially in bodily pain (0.5-0.6 SD), and vitality (0.6-0.8 SD).
Considering patients' well-being, AS can be a good therapeutic option due to the low impact caused on urinary continence and sexual function. However, longitudinal studies are required to take into account HRQoL evolution over time.
本研究旨在描述主动监测（AS）方案中局限性前列腺癌患者的健康相关生活质量（HRQoL），并将其与接受根治性前列腺切除术（RP）、外照射放疗（XRT）和近距离放疗（BT）的患者进行比较。
对 AS 方案中的多机构汇总横断面分析：<75 岁；病理证实局限性前列腺癌（最大 3 个阳性柱）；Gleason 评分<3+4；临床分期 T1a-T2b；PSA<15ng/ml。本研究的排除标准为：AS 不足 6 个月、AS 方案终止或数据不完整。根据风险组、从治疗选择到 HRQoL 调查的时间以及年龄，将 AS 中的患者与来自“西班牙临床局限性前列腺癌多中心研究”队列中接受 RP、XRT 或 BT 治疗的患者相匹配。完成前列腺特异性（EPIC）和通用（SF-36）HRQoL 量表。根据 HRQoL 调查时间（治疗选择后>2.5 年或<2.5 年）和年龄（>70 岁或<70 岁）进行分层分析。
396 例患者（每组 99 例）治疗选择至 HRQoL 调查的中位时间为 2.4 年（范围 0.5-8.3 年）。在治疗选择至 HRQoL 调查的两个时间分层中，AS 患者的尿失禁评分均高于 RP 患者（92.6 比 67.0 和 81.4 比 64.4，p<0.01）。治疗选择后<2.5 年的 AS 患者的性评分均高于任何主动治疗（p<0.01），但仅在治疗选择后 2.5 年以上的 AS 患者中统计学上高于 RP。AS 组与 RP 组在 EPIC 两个领域的差异程度均为中度（0.7 SD）至较大（1.0 SD）。无论应用何种治疗，患者的 SF-36 评分均与美国一般人群参考值相似且略有升高。尽管如此，治疗选择后<2.5 年的 AS 患者在身体状况领域的报告结果均不如其他治疗组，尤其是在身体疼痛（0.5-0.6 SD）和活力（0.6-0.8 SD）方面。
考虑到患者的整体健康状况，AS 可能是一种很好的治疗选择，因为其对尿失禁和性功能的影响较小。然而，需要进行纵向研究以考虑 HRQoL 随时间的演变。
