Wu Szu-Yuan, Huy Le Duc, Liao Chih Jung, Huang Chung-Chien
Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
Front Oncol. 2022 May 2;12:875036. doi: 10.3389/fonc.2022.875036. eCollection 2022.
To compare acute, subchronic, and chronic complications between older patients with high-risk localized prostate cancer (HR-LPC) receiving radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT).
We recruited older patients (≥80 years) with HR-LPC from the Taiwan Cancer Registry database. After propensity score matching, logistic regression analysis was used to compare the acute, subchronic, and chronic complication rates between patients who underwent RP (the RP group) and high-dose IMRT combined with long-term HT (the IMRT+HT group).
Benign prostatic hyperplasia (BPH) symptoms and urinary incontinence (UI) were the most common complications over 5 years (BPH symptoms: RP, 17.69%; IMRT+HT, 29.58%; UI: RP, 10.47%; IMRT+HT, 5.50%). Compared with the RP group, the IMRT+HT group had higher odds of BPH symptoms and lower odds of UI and hernia after the 5-year follow-up period. The impotence rates were significantly higher in the IMRT+HT group than in the RP group at 3 months and 1 year after treatment and became nonsignificant after 2 years. At 5 years after treatment, the IMRT+HT group had lower risks of UI (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.28-0.88) and hernia (aOR, 0.21; 95% CI, 0.11-0.82) and a higher risk of BPH symptoms (aOR, 4.15; 95% CI, 2.82-7.37) than the RP group.
IMRT+HT was associated with lower UI and hernia risks than RP. By contrast, RP was associated with fewer complications of BPH over the follow-up period and less impotence during the first year after treatment. Our findings provide important and valuable references for shared decision-making for optimal therapy selection among older men with HR-LPC.
比较接受根治性前列腺切除术（RP）的高危局限性前列腺癌（HR-LPC）老年患者与接受高剂量调强放射治疗（IMRT）联合长期激素治疗（HT）的患者的急性、亚慢性和慢性并发症。
我们从台湾癌症登记数据库中招募了年龄≥80岁的HR-LPC老年患者。在进行倾向评分匹配后，采用逻辑回归分析比较接受RP治疗的患者（RP组）和接受高剂量IMRT联合长期HT治疗的患者（IMRT+HT组）的急性、亚慢性和慢性并发症发生率。
良性前列腺增生（BPH）症状和尿失禁（UI）是5年期间最常见的并发症（BPH症状：RP组为17.69%；IMRT+HT组为29.58%；UI：RP组为10.47%；IMRT+HT组为5.50%）。与RP组相比，IMRT+HT组在5年随访期后出现BPH症状的几率更高，而出现UI和疝气的几率更低。治疗后3个月和1年时，IMRT+HT组的阳痿发生率显著高于RP组，2年后则无显著差异。治疗后5年，IMRT+HT组出现UI（调整优势比[aOR]，0.50；95%置信区间[CI]，0.28-0.88）和疝气（aOR，0.21；95%CI，0.11-0.82）的风险低于RP组，而出现BPH症状的风险高于RP组（aOR，4.15；95%CI，2.82-7.37）。
与RP相比，IMRT+HT导致UI和疝气的风险更低。相比之下，RP在随访期间BPH并发症较少，且治疗后第一年阳痿较少。我们的研究结果为HR-LPC老年男性选择最佳治疗方案的共同决策提供了重要且有价值的参考。
