Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
Department of Radiology, LMU University Hospital, Munich, Germany.
World J Urol. 2024 Apr 18;42(1):242. doi: 10.1007/s00345-024-04945-y.
Salvage radical prostatectomy (sRP) is an important treatment option for patients with recurrent prostate cancer (PCa) after radiotherapy (RT) or focal therapy (FT). However, health-related quality of life (HRQOL) after sRP depending on the primary treatment is understudied.
Patients who underwent Salvage RP for recurrent PCa were analyzed. The primary outcome of this study was HRQOL assessed by the quality-of-life questionnaire (QLQ)-C30 and its prostate specific QLQ-PR25 add-on. Secondary outcomes were functional outcome parameters (erectile function, continence) and biochemical recurrence-free survival (BRFS). Statistical analyses employed the chi-square test, Mann-Whitney U test, and Kaplan-Meier method, with a p value < 0.05 denoting significance.
37 patients with RT as primary treatment (RT-sRP) and 22 patients with focal therapy prior sRP (FT-sRP) were analyzed. Mean global health score was not significantly different preoperatively (71.9 vs. 67.3, p = 0.89) as well as after a median of 32 months follow-up (54.9 vs. 50.6, p = 0.63) with impaired HRQOL after sRP in both groups. Baseline erectile dysfunction was more prevalent in the RT-sRP group (mean IIEF-5: 5.0) than in the FT-sRP group (mean IIEF-5: 8.5, p = 0.037). No differences were observed at follow-up for erectile function (IIEF-5-Score: 0.5 vs 2.5, p = 0.199) and continence (continence rate: 48.4% vs 52.9% (p = 0.763) between the RT-sRP and FT-sRP group. 5-year-BRFS was 60% (RT-sRP) and 68% (FT-sRP, p = 0.849).
sRP impacts HRQOL in patients with PCa after RT and FT with no significant differences. Comparison with HRQOL and BRFS of treatment alternatives is paramount to counsel patients for appropriate treatments.
挽救性前列腺切除术（sRP）是放射治疗（RT）或局部治疗（FT）后复发性前列腺癌（PCa）患者的重要治疗选择。然而，取决于主要治疗方法的 sRP 后健康相关生活质量（HRQOL）研究较少。
分析了因复发性 PCa 而行挽救性 RP 的患者。本研究的主要结果是通过生活质量问卷（QLQ）-C30 及其前列腺特异性 QLQ-PR25 附加项评估的 HRQOL。次要结果是功能结局参数（勃起功能、控尿）和生化无复发生存率（BRFS）。采用卡方检验、Mann-Whitney U 检验和 Kaplan-Meier 法进行统计学分析，p 值<0.05 表示差异有统计学意义。
分析了 37 例 RT 作为主要治疗方法（RT-sRP）和 22 例 sRP 前接受 FT 的患者（FT-sRP）。术前两组的总体健康评分无显著差异（71.9 对 67.3，p=0.89），中位随访 32 个月后（54.9 对 50.6，p=0.63），两组 sRP 后 HRQOL 均受损。RT-sRP 组的基线勃起功能障碍更为常见（平均 IIEF-5：5.0），而 FT-sRP 组（平均 IIEF-5：8.5，p=0.037）。两组在随访时的勃起功能（IIEF-5 评分：0.5 对 2.5，p=0.199）和控尿（控尿率：48.4%对 52.9%（p=0.763）无差异。5 年 BRFS 为 60%（RT-sRP）和 68%（FT-sRP，p=0.849）。
RT 和 FT 后 sRP 对 PCa 患者的 HRQOL 有影响，但无显著差异。与治疗选择的 HRQOL 和 BRFS 进行比较对于为患者提供适当的治疗至关重要。
