Background

Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.

Objective

To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients.

Design, setting, and participants

The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up.

Outcome measurements and statistical analysis

Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.

Results and limitations

At 9–11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD = 5.9; 95% confidence interval or CI [0.5, 11.3] and AMD = 5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD = 5.3; 95% CI [0.2, 10.3] and AMD = 7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD = –9.1; 95% CI [–16.3, –2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD = –16.8; 95% CI [–27.6, –6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation.

Conclusions

Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups.

Patient summary

This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes.

中文翻译：

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低风险局限性前列腺癌诊断后主动监测和注意等待的长期心理和生活质量影响

背景

在决定是否对低风险的局部前列腺癌进行积极治疗时，长期的心理健康和生活质量是重要的考虑因素。

客观的

评估主动监测（AS）和/或观察等待（WW）对低危局限性前列腺癌患者心理和生活质量结局的长期影响。

设计，设置和参与者

前列腺癌护理和结果研究是一项基于人群的前瞻性队列研究，位于澳大利亚新南威尔士州。这些分析的参与者是诊断时年龄小于70岁的低危局限性前列腺癌患者，并参加了10年的随访。

成果测量和统计分析

经过验证的仪器评估了与六种健康相关的生活质量和九种与前列腺癌患者相关的心理领域有关的结果。使用线性回归估计前列腺癌治疗组之间结局评分的校正平均差异（AMDs）。

结果与局限性

在确诊后的9-11年，开始进行AS / WW的患者最初比（1）初始放疗/高剂量近距离放射治疗的患者有更高的窘迫和情绪亢进（AMD = 5.9； 95％的置信区间或CI [0.5， 11.3]和AMD = 5.4；分别为95％CI [0.2、10.5]），（2）比最初的低剂量率近距离放射治疗患者更高的痛苦和回避水平（AMD = 5.3； 95％CI [0.2、10.3]和AMD = 7.0；分别为95％CI [0.5、13.5]），（3）比最初的前列腺癌根治术患者尿失禁评分更高（AMD = –9.1； 95％CI [–16.3，–2.0]），和（4 ）比初始放疗/高剂量近距离放射治疗的患者肠蠕动少（AMD = –16.8; 95％CI [–27.6，–6.0]）。没有发现其他显着差异。局限性包括参与者流失，无法评估尿液排泄和贮藏症状，

结论

尽管AS / WW与各种积极治疗组之间在困扰，过度兴奋，回避，尿失禁和排便方面存在长期差异，但这些组之间的大多数长期结局相似。

病人总结

这项研究评估了最初监测而不是积极治疗低危前列腺癌的长期心理和生活质量影响。结果表明，最初的监测而不是积极的治疗对随后的长期心理和生活质量结果仅有很小的影响。