用于局部性前列腺癌的激活监测,手术,支臂疗法或外部光束辐射治疗或不使用的患者报告的结果
Karen E Hoffman1, David F Penson2, Zhiguo Zhao3
1Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston.
JAMA
|January 15, 2020
概括
对于局部性前列腺癌,大多数治疗副作用在5年内改善. 然而,与放射治疗相比,前列腺切除会导致持续性尿失禁和性功能恶化.
科学领域:
- 癌症学
- 尿道病学
- 医疗服务研究
背景情况:
- 了解前列腺癌治疗的长期功能结果对于明智的治疗选择至关重要.
- 目前治疗局部前列腺癌的方法包括积极监测,手术和放射治疗,
研究的目的:
- 为了比较患者在治疗有利风险和不利风险局部前列腺癌后5年的功能结果.
主要方法:
- 一项基于人口的前性队列研究包括2005名在2011-2012年间被诊断患有局部前列腺癌的男性.
- 使用扩大前列腺综合指数 (EPIC) 评估治疗后长达5年的功能结果.
- 调整了基线功能和患者/瘤特征的回归模型.
主要成果:
- 对于有利风险的疾病,与积极监测相比,神经节约性前列腺切除与更糟糕的尿失禁和性功能有关.
- 低剂量治疗显示1年后尿道,性功能和肠道功能较差,而不是积极监测.
- 在不良风险的疾病中,前列腺切除导致5年后与外辐射疗法与雄激素剥夺疗法 (EBRT与ADT) 相比,失禁和性功能更差.
结论:
- 大多数前列腺癌治疗方法之间的功能差异减少了5年.
- 前列腺切除在5年内始终导致临床意义上的失禁恶化.
- 在不良风险疾病中,前列腺切除术导致5年后的性功能恶化,而非ADT的EBRT.
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