Mitchell Jean M, Gresenz Carole Roan
McCourt School of Public Policy, Georgetown University, Washington, DC, USA.
Department of Health Systems Administration, Georgetown University, Washington, DC, USA.
Value Health. 2022 Nov;25(11):1863-1870. doi: 10.1016/j.jval.2022.06.006. Epub 2022 Aug 11.
This study aimed to examine adverse health outcomes associated with receipt of definitive treatments (prostatectomy, intensity-modulated radiation therapy [IMRT] and brachytherapy).
We identified men aged 65 years and older who received a new diagnosis of localized prostate cancer from 4 state cancer registries (CA, FL, NJ, and TX) during the years 2006 to 2013. We merged the registry records for this cohort with Medicare enrollment and claims. We constructed indicators of treatment-related adverse outcomes using diagnosis codes reported on the claims. Stage 1 models the choice of definitive treatment versus active surveillance. Stage 2 examines the probability of experiencing a treatment-related adverse health outcome among men who chose definitive treatment.
Notably, 81.4% of our cohort of 61 187 men received definitive treatment whereas 18.6% were monitored with active surveillance. The 5-year prostate cancer death rate was 0.28% to 1.75% irrespective of treatment received. Men monitored with active surveillance experienced minimal adverse health outcomes (0.16%-0.75%). The risks of urinary incontinence associated with prostatectomy were 31 and 39.5 percentage points higher than brachytherapy and IMRT, respectively. For erectile dysfunction, the risks were nearly 23 and 27.5 percentage points higher, respectively, than brachytherapy and IMRT. Prostatectomy was associated with lower risk of urinary dysfunction and bowel dysfunction than either brachytherapy or IMRT. Compared with brachytherapy, IMRT was associated with a lower risk of erectile dysfunction (32%), urinary incontinence (84%), and urinary dysfunction (30%).
This evidence should be of value to patient-physician decision making regarding the choice of definitive treatments versus active surveillance for men with localized disease.
本研究旨在探讨接受根治性治疗（前列腺切除术、调强放射治疗[IMRT]和近距离放射治疗）相关的不良健康结局。
我们确定了2006年至2013年期间从4个州癌症登记处（加利福尼亚州、佛罗里达州、新泽西州和得克萨斯州）新诊断为局限性前列腺癌的65岁及以上男性。我们将该队列的登记记录与医疗保险参保和理赔数据进行了合并。我们使用理赔报告中的诊断代码构建了与治疗相关不良结局的指标。第1阶段对根治性治疗与主动监测的选择进行建模。第2阶段研究选择根治性治疗的男性中出现与治疗相关不良健康结局的概率。
值得注意的是，我们队列中的61187名男性中有81.4%接受了根治性治疗，而18.6%接受了主动监测。无论接受何种治疗，5年前列腺癌死亡率为0.28%至1.75%。接受主动监测的男性经历的不良健康结局极少（0.16% - 0.75%）。与前列腺切除术相关的尿失禁风险分别比近距离放射治疗和IMRT高31和39.5个百分点。对于勃起功能障碍，风险分别比近距离放射治疗和IMRT高近23和27.5个百分点。与近距离放射治疗或IMRT相比，前列腺切除术与较低的排尿功能障碍和肠道功能障碍风险相关。与近距离放射治疗相比，IMRT与较低的勃起功能障碍（32%）、尿失禁（84%）和排尿功能障碍（30%）风险相关。
这一证据对于患者和医生在局限性疾病男性中选择根治性治疗与主动监测的决策应具有参考价值。
