Abdelhafez Ahmed, Hosny Khaled, El-Nahas Ahmed R, Liew Matthew
Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.
James Cook University Hospital, Middlesbrough, UK.
Arab J Urol. 2022 Feb 27;20(2):61-70. doi: 10.1080/2090598X.2021.2024368. eCollection 2022.
To examine the health-related quality of life (HRQoL) of patients with prostate cancer managed with active surveillance (AS) compared with those who receive definitive treatment using the Expanded Prostate Cancer Index Composite (EPIC) Survey.
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched PubMed and ScienceDirect for articles published between April 2010 and April 2020. Eligible studies reported original data on the HRQoL of men undergoing AS for prostate cancer, including studies comparing AS to curative methods particularly radical prostatectomy, radiotherapy, and brachytherapy.
We identified nine eligible articles, all were non-experimental observational studies of which seven were longitudinal and two were cross-sectional studies. The EPIC questionnaire was the main instrument used in all studies to assess the HRQoL. AS was noted to show the highest calculated mean score among management groups in all comparative studies at study endpoints including cross-sectional studies (95% confidence interval 2.17-5.75, < 0.001). The maximum score deterioration for patients who were managed with AS in all studies was only 7.5 points (12.2%) after 2 years follow-up. AS had the least mean score decline among all management groups. Patients with a normal testosterone level were found to have high HRQoL scores. The number of prostate biopsies did not correlate with the HRQoL score.
Patients with prostate cancer managed with AS report less impacts on their HRQoL compared to patients who receive definitive treatments. However, further high-quality research with long-term data are required to help both the patient and the physician in making a well-informed management decision.
使用扩展前列腺癌指数综合问卷（EPIC），比较接受主动监测（AS）的前列腺癌患者与接受确定性治疗的患者的健康相关生活质量（HRQoL）。
我们采用系统评价和Meta分析的首选报告项目（PRISMA）指南，在PubMed和ScienceDirect上检索2010年4月至2020年4月发表的文章。符合条件的研究报告了接受前列腺癌AS治疗的男性HRQoL的原始数据，包括将AS与根治性方法（特别是根治性前列腺切除术、放疗和近距离放疗）进行比较的研究。
我们确定了9篇符合条件的文章，均为非实验性观察性研究，其中7篇为纵向研究，2篇为横断面研究。EPIC问卷是所有研究中用于评估HRQoL的主要工具。在包括横断面研究在内的所有比较研究的研究终点，AS在所有管理组中显示出最高的计算平均得分（95%置信区间2.17 - 5.75，<0.001）。在所有研究中，接受AS治疗的患者在2年随访后的最大得分下降仅为7.5分（12.2%）。AS在所有管理组中的平均得分下降最少。发现睾酮水平正常的患者HRQoL得分较高。前列腺活检的次数与HRQoL得分无关。
与接受确定性治疗的患者相比，接受AS治疗的前列腺癌患者报告其HRQoL受到的影响较小。然而，需要进一步的高质量长期数据研究，以帮助患者和医生做出明智的管理决策。
