Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Can J Urol. 2020 Feb;27(27 Suppl 1):17-24.
The two major long-term concerns associated with different options for the management of prostate cancer, (including surgery, radiotherapy, brachytherapy, cryotherapy, HIFU, etc.) include difficulties with lower urinary tract symptoms (LUTS) and/or erectile dysfunction. LUTS can be in the form of stress urinary incontinence (SUI), urge urinary incontinence (UUI), frequency/urgency, and/or voiding difficulties. While surgery is mostly associated with SUI and radiation mostly results in UUI, there can be an overlap. Incontinence rates after cryotherapy and high intensity focused ultrasound (HIFU) are generally very low. Voiding difficulties can also happen after the above-mentioned options. Treatment of SUI can start with pelvic floor muscle exercises (PFME), penile clamps or urethral plugs. If these fail to provide satisfactory results the surgical options could include: urethral bulking agents, male slings, and artificial urinary sphincter (AUS). Surgical options are usually not recommended during the first 6-12 months after radical prostatectomy. Management of frequency, urgency and/or UUI can also be started with lifestyle modifications and PFME. Oral agents (anticholinergics and β3-agonists) are also considered before proceeding to third line options, such as Botox injection or sacral neuromodulation. The treatment options for ED resulting from the treatment of prostate cancer can include oral PDE5-I as the first line, local therapy as the second (such as MUSE, intracavernosal injections, and perhaps low intensity shock wave therapy) and finally surgery as the third line. Standard questionnaires and patient reported outcome measurement tools should be used for the assessment of LUTS and erectile dysfunction prior and after initiation of treatment to guide the management.
与前列腺癌管理的不同选择（包括手术、放疗、近距离治疗、冷冻治疗、高强度聚焦超声等）相关的两个主要长期问题是下尿路症状（LUTS）和/或勃起功能障碍。LUTS 可以表现为压力性尿失禁（SUI）、急迫性尿失禁（UUI）、尿频/尿急和/或排尿困难。手术主要与 SUI 相关，放疗主要导致 UUI，但两者可能存在重叠。冷冻治疗和高强度聚焦超声（HIFU）后的尿失禁发生率通常非常低。上述选择后也可能出现排尿困难。SUI 的治疗可以从骨盆底肌肉锻炼（PFME）、阴茎夹或尿道塞开始。如果这些方法不能提供满意的效果，可以选择手术治疗，包括尿道填充剂、男性吊带和人工尿道括约肌（AUS）。根治性前列腺切除术后的前 6-12 个月通常不建议选择手术治疗。通过生活方式改变和 PFME 也可以开始治疗尿频、尿急和/或 UUI。在考虑三线治疗，如肉毒杆菌毒素注射或骶神经调节之前，还可以考虑口服药物（抗胆碱能药物和β3-激动剂）。前列腺癌治疗引起的 ED 治疗选择可以包括口服 PDE5-I 作为一线治疗，局部治疗作为二线（如 MUSE、阴茎内注射，以及可能的低强度冲击波治疗），最后是手术作为三线治疗。在开始治疗之前和之后，应使用标准问卷和患者报告的结局测量工具评估 LUTS 和勃起功能障碍，以指导治疗管理。
