National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Scand J Urol. 2021 Feb;55(1):9-16. doi: 10.1080/21681805.2020.1854343. Epub 2020 Dec 21.
Few longitudinal studies have compared patient-reported long-term adverse effects after radical prostatectomy (RP) alone and RP followed by radiotherapy (RAD), also analyzing the effect of the development of post-treatment dysfunctions/problems (Symptom Burden) on Health-Related Quality of Life (HRQoL).
After median seven years since RP and six years since post-RP RAD, development of EPIC-26 Domain Summary Scores (DSS Changes) and HRQoL scores (SF-12) since the pre-RP situation were evaluated in respectively 317 prostatectomized men without and in 63 patients with additional post-RP RAD. Post-treatment inter-group differences of the prevalent Symptom Burden and of the DSS Changes were calculated. Multivariable logistic regressions evaluated the associations between DSS Changes and post-treatment impaired HRQoL.
Compared to RP alone, post-RP RAD increased the post-treatment Symptom Burden, with least inter-group differences within the urinary irritative/obstructive and bowel domain. No significant inter-group difference emerged for the proportions of men with impaired HRQoL. The odds of impaired HRQoL increased significantly with rising DSS Changes (worsening) within the vitality/hormonal domain. Worsening within urinary incontinence and bowel domains significantly increased the odds of impaired physical QoL. High HRQoL scores before RP reduced the odds of post-treatment impaired HRQoL. Living without a partner and use of androgen deprivation therapy increased this odds.
Post-RP radiotherapy increases post-treatment Symptom Burden with negative, though limited impact on the patient's HRQoL. Counceling before post-RP radiotherapy should cover this possible development, taking into account the patient's social situation.
很少有纵向研究比较过单纯根治性前列腺切除术（RP）和 RP 后放疗（RAD）后的患者报告的长期不良影响，也没有分析治疗后性功能障碍/问题（症状负担）的发展对健康相关生活质量（HRQoL）的影响。
在 RP 后中位数 7 年和 RP 后 RAD 后 6 年，评估了 317 名未接受额外 RP 后 RAD 的前列腺切除术患者和 63 名接受额外 RP 后 RAD 的患者的 EPIC-26 域综合评分（DSS 变化）和 HRQoL 评分（SF-12）自 RP 前的情况以来的发展情况。计算了治疗后组间普遍存在的症状负担和 DSS 变化的差异。多变量逻辑回归评估了 DSS 变化与治疗后 HRQoL 受损之间的关联。
与单纯 RP 相比，RP 后 RAD 增加了治疗后的症状负担，在尿激惹/梗阻和肠道域内的组间差异最小。在 HRQoL 受损的男性比例方面，两组之间没有显著差异。活力/激素域内 DSS 变化（恶化）的比例与 HRQoL 受损的可能性呈显著正相关。尿失禁和肠道域内恶化显著增加了物理 QoL 受损的可能性。RP 前较高的 HRQoL 评分降低了治疗后 HRQoL 受损的可能性。没有伴侣和使用雄激素剥夺疗法会增加这种可能性。
RP 后放疗增加了治疗后的症状负担，对患者的 HRQoL 产生了负面影响，但影响有限。在进行 RP 后放疗之前，应该考虑到患者的社会状况，为其提供关于这一可能发展的咨询。
