Department of Cancer Epidemiology and Prevention Research, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, 5th Floor, Holy Cross Centre, Box ACB, 2210 - 2 St. SW, Calgary, AB, T2S 3C3, Canada.
Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada.
BMC Urol. 2021 May 17;21(1):81. doi: 10.1186/s12894-021-00845-0.
To examine one-year trajectories of urinary and sexual outcomes, and correlates of these trajectories, among prostate cancer patients treated by radical prostatectomy (RP).
Study participants were recruited from 2011 to 2014 at two US institutions. Self-reported urinary and sexual outcomes were measured at baseline before surgery, and 5 weeks, 6 months and 12 months after surgery, using the modified Expanded Prostate Cancer Index Composite-50 (EPIC-50). Changes in EPIC-50 scores from baseline were categorized as improved (beyond baseline), maintained, or impaired (below baseline), using previously-reported minimum clinically important differences.
Of the 426 eligible participants who completed the baseline survey, 395 provided data on at least one EPIC-50 sub-scale at 5 weeks and 12 months, and were analyzed. Although all mean EPIC-50 scores declined markedly 5 weeks after surgery and then recovered to near (incontinence-related outcomes) or below (sexual outcomes) baseline levels by 12 months post-surgery, some men experienced improvement beyond their baseline levels on each sub-scale (3.3-51% depending on the sub-scale). Having benign prostatic hyperplasia (BPH) at baseline (prostate size ≥ 40 g; an International Prostate Symptom Index Score ≥ 8; or using BPH medications) was associated with post-surgical improvements in voiding dysfunction-related bother at 5 weeks (OR = 3.9, 95% CI: 2.1-7.2) and 12 months (OR = 3.3, 95% CI: 2.0-5.7); and in sexual bother at 5 weeks (OR = 5.7, 95% CI:1.7-19.3) and 12 months (OR = 3.0, 95% CI: 1.2-7.1).
Our findings provide additional support for considering baseline BPH symptoms when selecting the best therapy for early-stage prostate cancer.
本研究旨在探讨根治性前列腺切除术（RP）治疗后的前列腺癌患者，在一年时间内的尿控和性功能结局的变化轨迹，以及这些轨迹的相关因素。
研究参与者于 2011 年至 2014 年期间在美国的两个机构招募。在手术前、术后 5 周、6 个月和 12 个月时，使用改良版前列腺癌指数综合评分 50 项（EPIC-50），通过自我报告的方式，对尿控和性功能结局进行评估。根据先前报道的最小临床重要差异，将 EPIC-50 评分从基线的变化分为改善（优于基线）、维持或受损（低于基线）。
在 426 名符合条件的参与者中，有 395 名完成了基线调查，并提供了至少一项 EPIC-50 子量表在 5 周和 12 个月时的数据，因此被纳入分析。尽管所有 EPIC-50 评分的平均值在手术后 5 周时明显下降，并且在术后 12 个月时恢复到接近（尿失禁相关结局）或低于（性功能结局）基线水平，但一些男性在每个子量表上的评分都有所改善（3.3%-51%，具体取决于子量表）。基线时患有良性前列腺增生症（前列腺体积≥40g；国际前列腺症状指数评分≥8；或使用前列腺增生症药物）与术后 5 周时排尿功能障碍相关的困扰改善相关（OR=3.9，95%CI：2.1-7.2）和 12 个月时（OR=3.3，95%CI：2.0-5.7）；以及 5 周和 12 个月时的性功能困扰相关（OR=5.7，95%CI：1.7-19.3）和 12 个月时（OR=3.0，95%CI：1.2-7.1）。
本研究结果为在选择早期前列腺癌的最佳治疗方法时，考虑基线时的前列腺增生症症状提供了更多的支持。
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