Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands; Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Eur Urol Oncol. 2020 Feb;3(1):21-31. doi: 10.1016/j.euo.2018.12.004. Epub 2018 Dec 26.
Well-documented reports of patients' experiences with different treatments are important for helping localised prostate cancer (LPC) patients choose among the available treatment options.
To document differences in patient-reported outcomes (PROs) following radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), and active surveillance (AS), and to evaluate how these PROs and other factors are associated with treatment decision regret.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, observational, multicentre study of men diagnosed with LPC (stage cT1-2) during 2014-2016.
Patients completed validated PRO measures (Quality of Life Questionnaire Core 30 [QLQ-C30], Quality of Life Questionnaire prostate cancer-specific module [QLQ-PR25], Decision Regret Scale, and the Memorial Anxiety Scale for Prostate Cancer) before treatment and at 3, 6, and 12mo after treatment. Mixed-effect models were used to describe different PRO patterns.
The analytic cohort included 434 men (AS=32%; RP=45%; EBRT=12%; BT=10%). Follow-up response rates were above 90%. At 1-yr follow-up, (1) men who had received RP reported significantly (p<0.01) more urinary incontinence, sexual dysfunction, hormonal/masculinity-related symptoms, and less emotional distress; (2) those having received EBRT reported more sexual dysfunction, hormonal/masculinity-related symptoms, and physical distress; and (3) those having received BT reported more urinary obstruction and irritation symptoms, compared with patients under AS. Irrespective of the treatment modality, 23% of the patients reported clinically relevant treatment regret (99% confidence interval, 17-28%). Multivariate correlates of decision regret were hormonal/masculinity-related symptoms, educational level, and positive surgical margins.
Post-treatment physical and psychosocial functioning was significantly associated with specific treatment modalities and pretreatment functioning. Regret was relatively frequently reported by patients who experienced unwanted physical, psychosocial, and oncological outcomes. Greater efforts should be made to understand whether carefully educating patients about the possible consequences and effectiveness of treatments may help limit the feeling of treatment regret.
In men with localised prostate cancer, regret about the treatment choice was more common among those who experienced more treatment-related symptoms during the year after treatment.
详细记录患者对不同治疗方法的体验对于帮助局限性前列腺癌（LPC）患者在现有治疗方案中做出选择非常重要。
记录根治性前列腺切除术（RP）、外照射放疗（EBRT）、近距离放射治疗（BT）和主动监测（AS）治疗后患者报告的结局（PROs）的差异，并评估这些 PROs 和其他因素与治疗决策后悔之间的关系。
设计、地点和参与者：这是一项 2014 年至 2016 年期间对诊断为 LPC（cT1-2 期）的男性进行的前瞻性、观察性、多中心研究。
患者在治疗前和治疗后 3、6 和 12 个月时完成了经过验证的 PRO 测量（生活质量问卷核心 30 项[QLQ-C30]、前列腺癌特异性模块生活质量问卷[QLQ-PR25]、决策后悔量表和前列腺癌恐惧记忆量表）。采用混合效应模型描述不同的 PRO 模式。
分析队列包括 434 名男性（AS=32%；RP=45%；EBRT=12%；BT=10%）。随访应答率超过 90%。在 1 年随访时，（1）接受 RP 治疗的男性报告的尿失禁、性功能障碍、激素/男性化相关症状明显更多（p<0.01），情绪困扰更少；（2）接受 EBRT 治疗的男性报告的性功能障碍、激素/男性化相关症状和身体不适更多；（3）接受 BT 治疗的男性报告的尿梗阻和刺激症状更多，与 AS 治疗的患者相比。无论治疗方式如何，23%的患者报告了有临床意义的治疗后悔（99%置信区间，17-28%）。决策后悔的多变量相关因素是激素/男性化相关症状、教育水平和阳性切缘。
治疗后生理和心理社会功能与特定的治疗方式和治疗前功能显著相关。那些经历了不想要的生理、心理社会和肿瘤学结果的患者，报告治疗后悔的频率相对较高。应该更加努力地了解是否通过仔细教育患者治疗的可能后果和有效性，可以帮助限制治疗后悔的感觉。
在患有局限性前列腺癌的男性中，在治疗后 1 年内经历更多治疗相关症状的患者，对治疗选择的后悔更为常见。
