University of California San Diego School of Medicine, San Diego, CA.
Kelsey-Seybold Clinic, Department of Urology, Houston, TX.
Urol Oncol. 2023 Feb;41(2):104.e1-104.e9. doi: 10.1016/j.urolonc.2022.07.014. Epub 2022 Dec 17.
Prostate cancer is a widely common and treatable disease, and functional outcomes can greatly affect survivor quality of life. A retrospective review of the SEER-Medicare database was performed to identify patients who underwent prostate cancer treatment between January 1, 2004 and December 31, 2013 and review the rates of diagnosis and treatment of common functional side effects of surgery, radiation, or a combination of the 2 and perform a comparison of the outcomes. A total of 67,527 patients were included in the analysis. Radiation therapy (RT)-only compared to radical prostatectomy (RP)-only had lower rates of diagnosis of erectile dysfunction (30.4%, 95% CI 29.9%-30.9% vs. 56.1%, 95% CI 55.1%-57.04%, P < 0.0001), UI (29.7%, 95% CI 29.0%-30.3% vs. 44.5%, 95% CI 43.3%-45.6%, P < 0.0001), but higher rates of urethral stricture disease (8.44%, 95% CI 8.1%-8.8% vs. 5.35%, 95% CI 4.9%-5.9%, P < 0.0001), cystitis (33.1% 95% CI 32.4%-33.7% vs. 20.3%, 95% CI 19.2%-21.4%, P < 0.0001), and proctitis (14.7%, 95% CI 14.3%-15.1& vs. 2.75%, 95% CI 2.3%-3.3%, P < 0.0001). Compared to either single modality, the RP-then-RT group had higher incontinence medication use (12.0% 95% CI 10.8%-13.2% vs. 9.8%, 95% CI 9.5%-10.1% for RT-only and 8.3%, 95% CI 7.8%-8.8% for RP-only, P < 0.0001), overall incontinence therapy (18.5%, 95%CI 17.1%-20.0% vs. 10.2%, 95%CI 9.9%-10.5% for RT-only and 14.9%, 95% CI 14.3%-15.5% for RP-only, P < 0.0001), and stricture therapy (12.7%, 95% CI 11.5%-13.9% vs. 8.2%, 95% CI 8.0%-8.5% for RT-only and 9.1% 95% CI 8.6%-9.6% for RP-only, P < 0.0001). The RT-then-RP group had higher rates of stricture (25.4% compared to 8.2% for RT-only, 9.1% for RP-only, and 12.7% for RP-then-RT) and fistula (1.0% compared to 0.07% for RT-only, 0.18% for RP-only, and 0.092% for RP-then-RT) treatment than all the other groups. Multimodality therapy is generally associated with higher treatments rates for conditions such as erectile dysfunction , incontinence, urethral stricture disease , irritative cystitis and proctitis in patients older than 65. Radiation therapy followed by prostatectomy is associated with significantly worse functional outcomes. Patients undergoing or anticipating undergoing multimodality therapy for prostate cancer should be counseled regarding the possibility of increased risk of declining functional outcomes.
前列腺癌是一种广泛存在且可治疗的疾病，其功能结果对生存者的生活质量有很大影响。本研究回顾性分析了 SEER-Medicare 数据库中 2004 年 1 月 1 日至 2013 年 12 月 31 日期间接受前列腺癌治疗的患者，并对手术、放疗或两者联合治疗的常见功能副作用的诊断和治疗率进行了评估，并对结果进行了比较。共有 67527 例患者纳入分析。单纯放疗（RT）与单纯前列腺切除术（RP）相比，勃起功能障碍（30.4%，95%CI 29.9%-30.9%vs.56.1%，95%CI 55.1%-57.04%，P<0.0001）和尿失禁（29.7%，95%CI 29.0%-30.3%vs.44.5%，95%CI 43.3%-45.6%，P<0.0001）的诊断率较低，但尿道狭窄（8.44%，95%CI 8.1%-8.8%vs.5.35%，95%CI 4.9%-5.9%，P<0.0001）、膀胱炎（33.1%，95%CI 32.4%-33.7%vs.20.3%，95%CI 19.2%-21.4%，P<0.0001）和直肠炎（14.7%，95%CI 14.3%-15.1%vs.2.75%，95%CI 2.3%-3.3%，P<0.0001）的诊断率较高。与单一治疗模式相比，RP 后 RT 组的尿失禁药物使用率更高（12.0%，95%CI 10.8%-13.2%vs.9.8%，95%CI 9.5%-10.1%为 RT 组，8.3%，95%CI 7.8%-8.8%为 RP 组，P<0.0001），整体尿失禁治疗（18.5%，95%CI 17.1%-20.0%vs.10.2%，95%CI 9.9%-10.5%为 RT 组，14.9%，95%CI 14.3%-15.5%为 RP 组，P<0.0001）和狭窄治疗（12.7%，95%CI 11.5%-13.9%vs.8.2%，95%CI 8.0%-8.5%为 RT 组，9.1%，95%CI 8.6%-9.6%为 RP 组，P<0.0001）。与 RT 组和 RP 组相比，RT 后 RP 组的狭窄（25.4%比 RT 组的 8.2%、RP 组的 9.1%和 RP 后 RT 组的 12.7%）和瘘（1.0%比 RT 组的 0.07%、RP 组的 0.18%和 RP 后 RT 组的 0.092%）的治疗率更高。对于年龄大于 65 岁的患者，多模式治疗通常与较高的勃起功能障碍、尿失禁、尿道狭窄疾病、刺激性膀胱炎和直肠炎等疾病的治疗率相关。前列腺癌后行前列腺切除术与明显较差的功能结果相关。对于接受或预期接受前列腺癌多模式治疗的患者，应告知其功能结果下降风险增加的可能性。
