本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.26491

摘要内容如下：

重要性

与局限性前列腺癌治疗相关的不良结果尚不清楚。

目的

比较局限性前列腺癌特异性治疗的不良功能结果发生率。

设计、设置和参与者

一项观察性队列研究，使用来自5个美国监测、流行病学和最终结果计划登记处的数据。参与者在2011年至2012年间接受了局限性前列腺癌治疗。在基线检查时，1877人患有预后良好的前列腺癌（定义为CT1-CT2BN0M0，前列腺特异性抗原水平<20 ng/mL，1-2级组），568人患有预后不良的前列腺癌（定义为CT2CN0M0，前列腺特异性抗原水平20-50 ng/mL，或3-5级组）。随访数据通过调查问卷收集至2022年2月1日。

曝光

根治性前列腺切除术（n=1043）、体外放射治疗（n=359）、近距离放射治疗（n=96）或预后良好疾病的主动监测（n=379）和预后不良疾病的根治性前列腺切除术（n=362）或体外放射治疗联合雄激素剥夺治疗（n=206）。

主要成果和措施

结果是患者报告的性功能、泌尿功能、肠道功能和激素功能，使用26项扩展前列腺癌综合指数（范围0-100；100=最佳）。在治疗后10年，对相应的基线评分、患者和肿瘤特征进行调整，评估和比较特定疗法与每种结果的相关性。性功能的最小临床重要差异为10至12，尿失禁的最小临床重要差异为6至9，排尿刺激的最小临床重要差异为5至7，肠道和激素功能的最小临床重要差异为4至6。

结果

共有2445名局限性前列腺癌患者（中位年龄64岁；14%为黑人，8%为西班牙裔），平均随访时间为9.5年。在1877例预后良好的患者中，与主动监测相比，根治性前列腺切除术与更严重的尿失禁相关（校正平均差，-12.1[95%CI，-16.2至-8.0]），但与更差的性功能无关（校正平均差，-7.2[95%CI，-12.3至-2.0]）。在568例预后不良的患者中，根治性前列腺切除术与雄激素剥夺治疗的体外放射治疗相比，与更严重的尿失禁相关（校正均数差，-26.6[95%CI，-35.0至-18.2]），但与更差的性功能无关（校正均数差，-1.4[95%CI，-11.1至8.3）。在预后不良的患者中，与根治性前列腺切除术相比，体外放射治疗联合雄激素剥夺治疗与较差的肠道功能（校正平均差，-4.9[95%CI，-9.2至-0.7]）和激素功能（校正平均差，-4.9[95%CI，-9.5至-0.3]）相关。

结论和相关性

在接受局限性前列腺癌治疗的患者中，在10年的随访中，根治性前列腺切除术与预后较好的患者中的放疗或监测以及预后较差的患者中的放疗相比，与更严重的尿失禁相关，但与更差的性功能无关。在患有预后不良疾病的男性中，与根治性前列腺切除术相比，体外放射治疗联合雄激素剥夺疗法在10年随访时与更差的肠道和激素功能相关。

英文原文如下：

Abstracts

Importance  Adverse outcomes associated with treatments for localized prostate cancer remain unclear.

Objective  To compare rates of adverse functional outcomes between specific treatments for localized prostate cancer.

Design, Setting, and Participants  An observational cohort study using data from 5 US Surveillance, Epidemiology, and End Results Program registries. Participants were treated for localized prostate cancer between 2011 and 2012. At baseline, 1877 had favorable-prognosis prostate cancer (defined as cT1-cT2bN0M0, prostate-specific antigen level <20 ng/mL, and grade group 1-2) and 568 had unfavorable-prognosis prostate cancer (defined as cT2cN0M0, prostate-specific antigen level of 20-50 ng/mL, or grade group 3-5). Follow-up data were collected by questionnaire through February 1, 2022.

Exposures  Radical prostatectomy (n = 1043), external beam radiotherapy (n = 359), brachytherapy (n = 96), or active surveillance (n = 379) for favorable-prognosis disease and radical prostatectomy (n = 362) or external beam radiotherapy with androgen deprivation therapy (n = 206) for unfavorable-prognosis disease.

Main Outcomes and Measures  Outcomes were patient-reported sexual, urinary, bowel, and hormone function measured using the 26-item Expanded Prostate Cancer Index Composite (range, 0-100; 100 = best). Associations of specific therapies with each outcome were estimated and compared at 10 years after treatment, adjusting for corresponding baseline scores, and patient and tumor characteristics. Minimum clinically important differences were 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritation, and 4 to 6 for bowel and hormone function.

Results  A total of 2445 patients with localized prostate cancer (median age, 64 years; 14% Black, 8% Hispanic) were included and followed up for a median of 9.5 years. Among 1877 patients with favorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -12.1 [95% CI, -16.2 to -8.0]), but not worse sexual function (adjusted mean difference, -7.2 [95% CI, -12.3 to -2.0]), compared with active surveillance. Among 568 patients with unfavorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -26.6 [95% CI, -35.0 to -18.2]), but not worse sexual function (adjusted mean difference, -1.4 [95% CI, -11.1 to 8.3), compared with external beam radiotherapy with androgen deprivation therapy. Among patients with unfavorable prognosis, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel (adjusted mean difference, -4.9 [95% CI, -9.2 to -0.7]) and hormone (adjusted mean difference, -4.9 [95% CI, -9.5 to -0.3]) function compared with radical prostatectomy.

Conclusions and Relevance  Among patients treated for localized prostate cancer, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function at 10-year follow-up compared with radiotherapy or surveillance among people with more favorable prognosis and compared with radiotherapy for those with unfavorable prognosis. Among men with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year follow-up compared with radical prostatectomy.

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