Department of Radiation Oncology, Emory University, Atlanta, Georgia.
Department of Urology, Emory University, Atlanta, Georgia.
JAMA Netw Open. 2024 Oct 1;7(10):e2440747. doi: 10.1001/jamanetworkopen.2024.40747.
The association between radiotherapy (RT) timing after radical prostatectomy and long-term patient-reported health-related quality of life (HRQOL) in men with prostate cancer is unknown.
To measure long-term HRQOL in men with prostate cancer up to 15 years after prostatectomy with or without RT and examine whether early vs late postprostatectomy RT is associated with differences in sexual, urinary, and bowel HRQOL.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, multicenter, longitudinal cohort analysis using HRQOL data from the PROST-QA (2003-2006) and RP2 consortium (2010-2013) studies was conducted. Men with localized prostate cancer undergoing radical prostatectomy were included. Data were analyzed between May 8, 2023, and March 1, 2024. The study was conducted in 12 high-volume academic medical centers in the US.
Men were stratified based on receipt and timing of postprostatectomy RT: prostatectomy only, early RT (<12 months), and late RT (≥12 months).
Longitudinal sexual, incontinence, urinary irritation, bowel, and hormonal/vitality HRQOL were measured via the Expanded Prostate Cancer Index Composite at baseline; months 2, 6, and 12; and annually thereafter. Treatment groups were compared using multivariable linear mixed-effects models of change in longitudinal domain scores. Pad use for incontinence was measured longitudinally among men receiving postprostatectomy RT.
A total of 1203 men were included in the study: prostatectomy only (n = 1082), early RT (n = 57), and late RT (n = 64). Median age for the entire cohort was 60.5 (range, 38.8-79.7) years, and 1075 men (92.0%) were White. Median follow-up was 85.6 (IQR, 35.8-117.2) months. Compared with men receiving prostatectomy alone, those receiving postprostatectomy RT had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL. However, timing of postprostatectomy RT, specifically early vs late, was not associated with a long-term decrease in any HRQOL domain. There was evidence of improved recovery of sexual, continence, and urinary irritation scores among men receiving early RT compared with those receiving late RT after prostatectomy. Before the start of postprostatectomy RT, 39.3% of men in the early RT cohort and 73.4% of men in the late RT cohort were pad-free. By the sixth visit post-RT, 67.4% in the early RT cohort and 47.6% in the late RT cohort were pad-free.
In this multicenter, prospective analysis, postprostatectomy RT appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy RT may result in similar long-term HRQOL outcomes.
根治性前列腺切除术后放疗（RT）时机与前列腺癌患者长期报告的健康相关生活质量（HRQOL）之间的关联尚不清楚。
测量前列腺癌患者前列腺切除术后长达 15 年的长期 HRQOL，并用或不用 RT，并检查早期与晚期前列腺切除术后 RT 是否与性、尿和肠 HRQOL 的差异相关。
设计、地点和参与者：使用来自 PROST-QA（2003-2006 年）和 RP2 联盟（2010-2013 年）研究的 HRQOL 数据进行了一项前瞻性、多中心、纵向队列分析。纳入接受根治性前列腺切除术的局限性前列腺癌患者。数据分析于 2023 年 5 月 8 日至 2024 年 3 月 1 日进行。该研究在美国 12 家高容量学术医疗中心进行。
根据前列腺切除术后 RT 的接受和时机对男性进行分层：前列腺切除术仅、早期 RT（<12 个月）和晚期 RT（≥12 个月）。
通过基线时的扩展前列腺癌指数综合量表，纵向测量性、尿失禁、尿激惹、肠和激素/活力 HRQOL；在第 2、6 和 12 个月以及此后每年进行一次测量。使用纵向域评分变化的多变量线性混合效应模型比较治疗组。对接受前列腺切除术后 RT 的男性进行纵向尿失禁垫使用测量。
共有 1203 名男性参与了这项研究：前列腺切除术仅（n=1082）、早期 RT（n=57）和晚期 RT（n=64）。整个队列的中位年龄为 60.5 岁（范围，38.8-79.7），1075 名男性（92.0%）为白人。中位随访时间为 85.6（IQR，35.8-117.2）个月。与仅接受前列腺切除术的男性相比，接受前列腺切除术后 RT 的男性在性、尿失禁和尿激惹 HRQOL 方面的下降更为明显。然而，前列腺切除术后 RT 的时机，特别是早期与晚期，与任何 HRQOL 域的长期下降均无关联。在前列腺切除术后，与接受晚期 RT 的男性相比，接受早期 RT 的男性在性、尿失禁和尿激惹评分的恢复方面有证据表明有所改善。在开始前列腺切除术后 RT 之前，早期 RT 队列中有 39.3%的男性和晚期 RT 队列中有 73.4%的男性没有使用尿垫。在 RT 后的第六次就诊时，早期 RT 队列中有 67.4%的男性和晚期 RT 队列中有 47.6%的男性没有使用尿垫。
在这项多中心、前瞻性分析中，前列腺切除术后 RT 似乎与所有 HRQOL 领域的长期 HRQOL 呈负相关。然而，接受早期与晚期前列腺切除术后 RT 可能会产生相似的长期 HRQOL 结果。
