Thériault Roxann, Ismail Salima, Morin Catherine, Bouchard Frédérique, Tétreault-Laflamme Audrey, Richard Patrick O, Jeldres Claudio, Tu Le Mai
Department of Surgery, Division of Urology, CHUS - Hôpital Fleurimont, Sherbrooke, Québec, Canada.
Department of Radiation Oncology, CHUS - Hôpital Fleurimont, Sherbrooke, Québec, Canada.
World J Urol. 2025 Aug 18;43(1):503. doi: 10.1007/s00345-025-05532-5.
Although short-term complications of external beam radiotherapy (EBRT), radical prostatectomy (RP), or a combination of both (RP/EBRT) for prostate cancer have been extensively reported, data on long-term complications are under-reported. The primary objective was to compare the rates and severity of long-term genitourinary (GU) toxicity of EBRT, RP, and RP/EBRT. The secondary objective was to assess patient- and treatment-related risk factors for GU toxicity.
We retrospectively examined the charts of prostate cancer patients who received EBRT, RP, or RP/EBRT between 2010 and 2018 at Sherbrooke University Hospital Center (QC, Canada). Baseline patient characteristics, treatment-related information, and late GU complications (> 1-year post-treatment) were extracted.
The study included 1246 patients, of which 694 (55.7%), 380 (30.5%), and 172 (13.8%) received EBRT, RP, and RP/EBRT, respectively. Mean follow-up was 6.2 years (range, 1.5-12.2). Based on the Common Terminology Criteria for Adverse Events, EBRT group had 202 (29.1%) grade 2 and 38 (5.5%) grade 3 complications, compared to 66 (17.4%) grade 2 and 32 (8.4%) grade 3 for RP patients (p < 0.001). The RP/EBRT group had 58 (33.7%) grade 2 and 29 (16.9%) grade 3 complications (p < 0.001). No patient-related risk factor significantly increased the rate of GU toxicity, except for anticoagulation.
Patients who underwent RP/EBRT had the highest rate and severity of complications. Although EBRT patients had a higher rate of GU toxicity, it was less severe than RP patients. This reinforces the importance of fully disclosing risks and types of complications when discussing treatment options.
尽管关于前列腺癌的外照射放疗（EBRT）、根治性前列腺切除术（RP）或两者联合（RP/EBRT）的短期并发症已有大量报道，但长期并发症的数据报道不足。主要目的是比较EBRT、RP和RP/EBRT的长期泌尿生殖系统（GU）毒性的发生率和严重程度。次要目的是评估与GU毒性相关的患者和治疗风险因素。
我们回顾性研究了2010年至2018年在加拿大魁北克省舍布鲁克大学医院中心接受EBRT、RP或RP/EBRT的前列腺癌患者的病历。提取了患者的基线特征、治疗相关信息以及晚期GU并发症（治疗后>1年）。
该研究纳入了1246例患者，其中694例（55.7%）、380例（30.5%）和172例（13.8%）分别接受了EBRT、RP和RP/EBRT。平均随访时间为6.2年（范围1.5 - 12.2年）。根据不良事件通用术语标准，EBRT组有202例（29.1%）2级并发症和38例（5.5%）3级并发症，而RP患者有66例（17.4%）2级并发症和32例（8.4%）3级并发症（p<0.001）。RP/EBRT组有58例（33.7%）2级并发症和29例（16.9%）3级并发症（p<0.001）。除抗凝外，没有患者相关风险因素会显著增加GU毒性的发生率。
接受RP/EBRT的患者并发症发生率和严重程度最高。尽管EBRT患者的GU毒性发生率较高，但其严重程度低于RP患者。这强化了在讨论治疗方案时充分披露并发症风险和类型的重要性。
