Context

Current evidence-based management for clinically localised prostate cancer includes active surveillance, surgery, external beam radiotherapy (EBRT) and brachytherapy. The impact of these treatment modalities on quality of life (QoL) is uncertain.

Objective

To systematically review comparative studies investigating disease-specific QoL outcomes as assessed by validated cancer-specific patient-reported outcome measures with at least 1 yr of follow-up after primary treatment for clinically localised prostate cancer.

Evidence acquisition

MEDLINE, EMBASE, AMED, PsycINFO, and Cochrane Library were searched to identify relevant studies. Studies were critically appraised for the risk of bias. A narrative synthesis was undertaken.

Evidence synthesis

Of 11 486 articles identified, 18 studies were eligible for inclusion, including three randomised controlled trials (RCTs; follow-up range: 60–72 mo) and 15 nonrandomised comparative studies (follow-up range: 12–180 mo) recruiting a total of 13 604 patients. Two RCTs recruited small cohorts and only one was judged to have a low risk of bias. The quality of evidence from observational studies was low to moderate. For a follow-up of up to 6 yr, active surveillance was found to have the lowest impact on cancer-specific QoL, surgery had a negative impact on urinary and sexual function when compared with active surveillance and EBRT, and EBRT had a negative impact on bowel function when compared with active surveillance and surgery. Data from one small RCT reported that brachytherapy has a negative impact on urinary function 1 yr post-treatment, but no significant urinary toxicity was reported at 5 yr.

Conclusions

This is the first systematic review comparing the impact of different primary treatments on cancer-specific QoL for men with clinically localised prostate cancer, using validated cancer-specific patient-reported outcome measures only. There is robust evidence that choice of primary treatment for localised prostate cancer has distinct impacts on patients’ QoL. This should be discussed in detail with patients during pretreatment counselling.

Patient summary

Our review of the current evidence suggests that for a period of up to 6 yr after treatment, men with localised prostate cancer who were managed with active surveillance reported high levels of quality of life (QoL). Men treated with surgery reported mainly urinary and sexual problems, while those treated with external beam radiotherapy reported mainly bowel problems. Men eligible for brachytherapy reported urinary problems up to a year after therapy, but then their QoL returned gradually to as it was before treatment.

中文翻译：

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临床上局部前列腺癌的主要治疗后的生活质量结果：系统评价。

语境

当前针对临床上局限性前列腺癌的循证管理包括主动监测，手术，外束放射疗法（EBRT）和近距离放射疗法。这些治疗方式对生活质量（QoL）的影响尚不确定。

客观的

为了系统地审查比较研究，该研究调查了针对特定疾病的QoL结局，这些结果由经过验证的针对癌症的患者报告的结局指标进行了评估，并在临床治疗局部前列腺癌的主要治疗后至少进行了1年的随访。

取证

搜索MEDLINE，EMBASE，AMED，PsycINFO和Cochrane库，以识别相关研究。对研究的偏倚风险进行了严格评估。进行了叙事综合。

证据综合

在确定的11 486篇文章中，有18项研究符合纳入条件，包括3项随机对照试验（RCT；随访范围：60–72个月）和15项非随机比较研究（随访范围：12–180个月），共募集13 604名患者中。两名RCT招募了小批研究对象，只有一名被判定具有较低的偏见风险。观察性研究的证据质量低到中等。在长达6年的随访中，发现主动监测对癌症特异性QoL的影响最小，与主动监测和EBRT相比，手术对尿液和性功能的负面影响，而EBRT则具有负面影响与主动监测和手术相比，对肠道功能的影响更大。一项小型RCT的数据报道，近距离治疗对治疗后1年的泌尿功能有负面影响，

结论

这是第一项系统评价，仅使用经过验证的针对癌症的患者报告的结局指标，比较了不同主要治疗方法对临床上局限性前列腺癌男性的癌症特异性QoL的影响。有强有力的证据表明，选择局部前列腺癌的主要治疗方法会对患者的生活质量产生明显影响。在治疗前咨询期间应与患者进行详细讨论。

病人总结

我们对当前证据的回顾表明，在治疗后长达6年的时间里，接受了主动监测的局限性前列腺癌男性的生活质量（QoL）高。接受手术治疗的男性主要报告泌尿和性问题，而接受外部束放射疗法的男性主要报告肠道问题。有资格接受近距离放射治疗的男性在治疗后的一年内都报告了泌尿问题，但随后他们的生活质量逐渐恢复到治疗前的水平。