Virginia Mason Medical Center, Seattle, WA.
Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation, Bethesda, MD.
Urol Oncol. 2020 Oct;38(10):794.e1-794.e9. doi: 10.1016/j.urolonc.2020.02.007. Epub 2020 Mar 3.
Combined radiotherapy and hormonal treatment are recommended for intermediate- and high-risk prostate cancer (CaP). This study compared the long-term effects on health-related quality of life (HRQoL) of intermediate- and high-risk CaP patients managed with radiation therapy (RT) with vs. without hormone therapy (HT).
Patients with intermediate- and high-risk CaP enrolled in the Center for Prostate Disease Research diagnosed from 2007 to 2017 were included. EPIC and SF-36 questionnaires were completed and HRQoL scores were compared for patients receiving RT vs. RT + HT at baseline (pretreatment), 6, 12, 24, 36, 48, and 60 months after CaP diagnosis. Longitudinal patterns of change in HRQoL were modeled using linear regression models, adjusting for baseline HRQoL, age at CaP diagnosis, race, comorbidities, National Comprehensive Cancer Network (NCCN) risk stratum, time to treatment, and follow-up time.
Of 164 patients, 93 (56.7%) received RT alone and 71 (43.3%) received RT + HT. Both groups reported comparable baseline HRQoL. Patients receiving RT+HT were more likely to be NCCN high risk as compared to those receiving only RT. The RT + HT patients experienced worse sexual function, hormonal function, and hormonal bother than those who only received RT; however, HRQoL recovered over time for the RT + HT group. No significant differences were observed between groups in urinary and bowel domains or SF-36 mental and physical scores.
Combined RT + HT treatment was associated with temporary lower scores in sexual and hormonal HRQoL compared with RT only. Intermediate- and high-risk CaP patients should be counseled about the possible declines in HRQoL associated with HT.
联合放疗和激素治疗被推荐用于中高危前列腺癌（CaP）。本研究比较了中高危 CaP 患者接受放疗（RT）与接受 RT 联合激素治疗（HT）对健康相关生活质量（HRQoL）的长期影响。
纳入了 2007 年至 2017 年在前列腺疾病研究中心诊断为中高危 CaP 的患者。在 CaP 诊断后 6、12、24、36、48 和 60 个月时，比较了接受 RT 与 RT+HT 的患者完成的 EPIC 和 SF-36 问卷和 HRQoL 评分。使用线性回归模型对 HRQoL 的纵向变化模式进行建模，调整了基线 HRQoL、CaP 诊断时的年龄、种族、合并症、美国国家综合癌症网络（NCCN）风险分层、治疗时间和随访时间。
在 164 名患者中，93 名（56.7%）仅接受 RT，71 名（43.3%）接受 RT+HT。两组患者报告的基线 HRQoL 相当。与仅接受 RT 的患者相比，接受 RT+HT 的患者更有可能属于 NCCN 高危人群。接受 RT+HT 的患者在性功能、激素功能和激素困扰方面的 HRQoL 较仅接受 RT 的患者差，但 RT+HT 组的 HRQoL 随时间恢复。两组在尿和肠域以及 SF-36 心理和生理评分方面无显著差异。
与仅接受 RT 相比，联合 RT+HT 治疗与暂时性的性功能和激素 HRQoL 评分下降相关。中高危 CaP 患者应被告知与 HT 相关的 HRQoL 可能下降。
