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首页> 外文期刊>The journal of sexual medicine >Is a Treatment Delay in Radical Prostatectomy Safe in Individuals with Low-Risk Prostate Cancer?
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Is a Treatment Delay in Radical Prostatectomy Safe in Individuals with Low-Risk Prostate Cancer?

机译：低危前列腺癌患者根治性前列腺癌的治疗延迟是否安全？

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Introduction. Many patients diagnosed with localized prostate cancer (PCa) are presented with several treatment modalities, which may require time to understand these options before making an informed decision regarding treatment. Aim. The aim of this study was to compare the effect of radical prostatectomy (RP) delay on postoperative functional outcomes and mortality in a North American population-based cohort. Methods. Overall, 17,153 men treated with RP for non-metastatic clinical stage T1-2, low-grade PCa between years 1995 and 2005 within the U.S. Surveillance, Epidemiology, and End Results Medicare-linked database were abstracted. Main Outcome Measures. The effect of treatment delay (from PCa diagnosis to RP of >3 months) on pathological upstaging at surgery (≥pT3) and postoperative functional outcomes (urinary incontinence and erectile dysfunction) was examined using logistic regression analyses. The 10-year PCa mortality rates were computed using cumulative incidence rates. Results. Overall, 2,576 (15%) patients underwent RP>3 months after diagnosis. A treatment delay of >3 months was associated with a 24% and 33% higher rate of erectile dysfunction diagnosis and procedure, respectively (both P≤0.001). Treatment delay was also associated with 6% higher rate of urinary incontinence procedure (P=0.01). Furthermore, a dose-response effect was detected with respect to increasing durations of RP delay (≤3 vs. 3-5 vs. 5-9 vs. ≥9 months) the rates of erectile dysfunction and urinary incontinence diagnoses/procedures. Treatment delay was not associated with pathological upstaging and PCa mortality. Conclusions. Customarily, the timing of RP following biopsy is dictated by tumor aggressiveness. In general, patients with more unfavorable characteristics are operated sooner. This may obliterate the potential detriments of delayed RP. The treatment delay between biopsy and RP may result in more extensive periprostatic tissue resection and may adversely affect postoperative continence and erectile function.
机译：介绍。许多诊断为局限性前列腺癌（PCa）的患者都有几种治疗方式，在做出有关治疗的明智决定之前，可能需要一些时间来理解这些选择。目标。这项研究的目的是比较北美人群为基础的队列研究中前列腺癌根治术（RP）延迟对术后功能结局和死亡率的影响。方法。总体而言，在美国监测，流行病学和最终结果与医疗保险相关的数据库中，从1995年至2005年之间，共收治了17153例接受RP治疗的非转移性T1-2临床阶段，低级PCa患者。主要观察指标。使用逻辑回归分析检查了治疗延迟（从PCa诊断到RP> 3个月）对手术病理升级（≥pT3）和术后功能结局（尿失禁和勃起功能障碍）的影响。使用累积发生率计算10年PCa死亡率。结果。总体而言，诊断后2 576例（15％）患者接受了RP> 3个月。延迟> 3个月的治疗分别使勃起功能障碍的诊断率和手术率分别提高24％和33％（均P≤0.001）。治疗延迟也与尿失禁手术率高6％有关（P = 0.01）。此外，对于勃起功能障碍和尿失禁的诊断/程序，随着RP延迟持续时间的增加（≤3vs. 3-5 vs. 5-9 vs.≥9个月），发现了剂量反应效应。治疗延迟与病理分期和PCa死亡率无关。结论。通常，活检后RP的时机由肿瘤的侵袭性决定。通常，具有较不利特征的患者应尽快手术。这可以消除延迟RP的潜在危害。活检和RP之间的治疗延迟可能会导致更广泛的前列腺周围组织切除术，并可能对术后的自控力和勃起功能产生不利影响。

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