Falkenbach Fabian, Mazzucato Giovanni, Tian Zhe, Karakiewicz Pierre I, Graefen Markus, Steuber Thomas, Tilki Derya, Koehler Daniel, Beyer Burkhard, Tennstedt Pierre, Knipper Sophie, Budäus Lars, Maurer Tobias
Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Eur Urol Open Sci. 2024 Oct 10;70:1-7. doi: 10.1016/j.euros.2024.09.010. eCollection 2024 Dec.
In patients with oligorecurrent prostate cancer (PCa), prostate-specific membrane antigen-targeted radioguided surgery (PSMA-RGS) prolongs treatment-free survival. Data on patient-reported outcome measures (PROMs) are lacking.
A retrospective assessment of validated PROMs (12-item Short Form Health Survey [SF-12], 26-item Expanded Prostate Index Composite, and Decision Regret Scale [DRS]) was performed before and after PSMA-RGS for oligorecurrent PCa. Mixed models were used.
A total of 373 patients were analyzed at a median (interquartile range [IQR]) age of 66 (61, 70) yr and prostate-specific antigen of 0.8 (0.4, 1.5) ng/ml. Six months after PSMA-RGS, the median (IQR) scores for the PROMs were as follows: SF-12 physical 54 (49, 56), SF-12 mental 53 (43, 56), urinary incontinence 86 (52, 100), urinary irritation 94 (88, 100), sexual 27 (9, 57), hormonal 90 (79, 100), and bowel 96 (83, 100). Only the sexual score decreased in a significant fashion from baseline over time (median [IQR], 17 [8,38]) after 3 yr vs 37 [13, 63] at baseline, = 0.01). The decision regret remained low (median [IQR] DRS at 1 yr: 5 [0, 20]). More than 90% of the patients reported that PSMA-RGS was the correct decision after 1 yr.
We recorded no significant decrease in quality of life or any functional status domain, except sexual. While decision regret was low, sexual functioning might deteriorate further.
No significant deterioration in health-related quality of life was reported after removing early prostate cancer metastases. Very few patients expressed remorse about their decision for salvage surgery.
在寡转移复发性前列腺癌（PCa）患者中，前列腺特异性膜抗原靶向放射性引导手术（PSMA-RGS）可延长无治疗生存期。目前缺乏患者报告结局指标（PROMs）的数据。
对寡转移复发性PCa患者在PSMA-RGS前后进行回顾性评估，采用经过验证的PROMs（12项简短健康调查问卷[SF-12]、26项扩展前列腺指数综合量表和决策后悔量表[DRS]）。使用混合模型。
共分析了373例患者，中位（四分位间距[IQR]）年龄为66（61，70）岁，前列腺特异性抗原为0.8（0.4，1.5）ng/ml。PSMA-RGS后6个月，PROMs的中位（IQR）得分如下：SF-12身体维度54（49，56），SF-12心理维度53（43，56），尿失禁86（52，100），尿路刺激94（88，100），性功能27（9，57），激素相关90（79，100），肠道功能96（83，100）。仅性功能得分随时间从基线显著下降（3年后中位[IQR]，17[8，38]），而基线时为37[13，63]，P=0.01）。决策后悔程度仍然较低（1年时DRS中位[IQR]：5[0，20]）。超过90%的患者报告1年后PSMA-RGS是正确的决定。
除性功能外，我们未发现生活质量或任何功能状态领域有显著下降。虽然决策后悔程度较低，但性功能可能会进一步恶化。
在切除早期前列腺癌转移灶后，未报告健康相关生活质量有显著恶化。极少数患者对其挽救性手术的决定表示后悔。
