Kord Eyal, Jung Nathan, Posielski Natasza, Jiang Jiji, Elsamanoudi Sally, Chesnut Gregory T, Speir Ryan, Stroup Sean, Musser John, Ernest Alexander, Tausch Timothy, Flores John Paul, Porter Christopher
Virginia Mason Franciscan Health Medical Center, Seattle, WA, USA.
Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Eur Urol Open Sci. 2022 Dec 27;48:60-69. doi: 10.1016/j.euros.2022.12.006. eCollection 2023 Feb.
Localized prostate cancer (PCa) treatment is associated with reduced health-related quality of life (HRQoL). Current literature is limited by short-term follow-up.
To prospectively evaluate the 5-yr HRQoL outcomes in men undergoing radical prostatectomy (RP), external beam radiotherapy (EBRT), or active surveillance (AS).
We prospectively evaluated HRQoL in patients with low-risk/favorable intermediate-risk PCa enrolled in the Center for Prostate Disease Research multicenter database between 2007 and 2017.
Of 1012 patients included in the study, 252 (24.9%) underwent AS, 557 (55.0%) RP, and 203 (20.0%) EBRT. Patients complete the Expanded Prostate Cancer Index Composite and the 36-item Medical Outcomes Study Short Form at baseline and thereafter each year up to 5 yr after treatment.
Temporal changes in HRQoL were compared between treatments and were modeled using linear regression models adjusted for baseline HRQoL, demographic, and clinical characteristics.
RP showed the least irritative symptoms and worse incontinence in comparison with AS ( < 0.001 for both subdomains) or EBRT ( < 0.001 for both subdomains) at all time points. RP sexual domain score was worse than the scores of AS (mean difference 22.3 points, 95% confidence interval [CI] 10.5-27.8, < 0.001) and EBRT (mean difference 16.9 points, 95% CI 12.5-20.3, < 0.001) during years 1-3 and not different from that of EBRT (mean difference 2.9 points, 95% CI -4.8 to 8.3, = 0.3) at years 4 and 5. Bowel function and bother were worse for EBRT than for AS ( < 0.001 for both subdomains) and RP ( < 0.001 for both subdomains) at all time points. During the 3-5-yr period, AS demonstrated the worst decline in all mental health domains ( < 0.001 in comparison with both EBRT and RP).
RP results in worse long-term urinary function and incontinence, but in less irritative and obstructive symptoms than EBRT and AS. Sexual domain scores were least affected by AS, while RP shows similar scores to EBRT at long term. Long-term HRQoL changes are critical for advising patients.
We evaluated long-term health-related quality of life (HRQoL) in a large US population treated for localized prostate cancer. HRQoL outcomes varied according to treatment modality and time. These changes should inform patients about their expected outcomes following treatment.
局限性前列腺癌（PCa）的治疗与健康相关生活质量（HRQoL）下降有关。目前的文献受短期随访的限制。
前瞻性评估接受根治性前列腺切除术（RP）、外照射放疗（EBRT）或主动监测（AS）的男性患者5年的HRQoL结局。
设计、设置和参与者：我们前瞻性评估了2007年至2017年纳入前列腺疾病研究中心多中心数据库的低风险/有利中风险PCa患者的HRQoL。
在纳入研究的1012例患者中，252例（24.9%）接受了AS，557例（55.0%）接受了RP，203例（20.0%）接受了EBRT。患者在基线时以及治疗后每年直至5年完成扩展前列腺癌指数综合量表和36项医学结局研究简表。
比较不同治疗方法之间HRQoL的时间变化，并使用针对基线HRQoL、人口统计学和临床特征进行调整的线性回归模型进行建模。
在所有时间点，与AS（两个子领域均P<0.001）或EBRT（两个子领域均P<0.001）相比，RP的刺激性症状最少，但尿失禁情况更差。在第1至3年，RP的性功能领域评分比AS（平均差异22.3分，95%置信区间[CI]10.5-27.8，P<0.001）和EBRT（平均差异16.9分，95%CI 12.5-20.3，P<0.001）更差，在第4年和第5年与EBRT无差异（平均差异2.9分，95%CI -4.8至8.3，P=0.3）。在所有时间点，EBRT的肠道功能和困扰比AS（两个子领域均P<0.001）和RP（两个子领域均P<0.001）更差。在3至5年期间，AS在所有心理健康领域的下降最为明显（与EBRT和RP相比均P<0.001）。
RP导致长期泌尿系统功能和尿失禁情况更差，但与EBRT和AS相比，刺激性和梗阻性症状更少。性功能领域评分受AS的影响最小，而RP长期来看与EBRT的评分相似。长期HRQoL变化对于为患者提供建议至关重要。
我们评估了美国一大群接受局限性前列腺癌治疗患者的长期健康相关生活质量（HRQoL）。HRQoL结局因治疗方式和时间而异。这些变化应告知患者治疗后的预期结局。
