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首页> 外文期刊>European urology >Long-term distress after radical prostatectomy versus watchful waiting in prostate cancer: A longitudinal study from the Scandinavian Prostate Cancer Group-4 randomized clinical trial
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Long-term distress after radical prostatectomy versus watchful waiting in prostate cancer: A longitudinal study from the Scandinavian Prostate Cancer Group-4 randomized clinical trial

机译：前列腺癌根治性前列腺切除术后的长期困扰与警惕的等待：来自斯堪的纳维亚前列腺癌第4组的随机临床研究的纵向研究

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Background: Studies enumerating the dynamics of physical and emotional symptoms following prostate cancer (PCa) treatment are needed to guide therapeutic strategy. Yet, overcoming patient selection forces is a formidable challenge for observational studies comparing treatment groups. Objective: To compare patterns of symptom burden and distress in men with localized PCa randomized to radical prostatectomy (RP) or watchful waiting (WW) and followed up longitudinally. Design, setting, and participants: The three largest, Swedish, randomization centers for the Scandinavian Prostate Cancer Group-4 trial conducted a longitudinal study to assess symptoms and distress from several psychological and physical domains by mailed questionnaire every 6 mo for 2 yr and then yearly through 8 yr of follow-up. Intervention: RP compared with WW. Outcome measurements and statistical analysis: A questionnaire was mailed at baseline and then repeatedly during follow-up with questions concerning physical and mental symptoms. Each analysis of quality of life was based on a dichotomization of the outcome (yes vs no) studied in a binomial response, generalized linear mixed model. Results and limitations: Of 347 randomized men, 272 completed at least five questionnaires during an 8-yr follow-up period. Almost all men reported that PCa negatively influenced daily activities and relationships. Health-related distress, worry, feeling low, and insomnia were consistently reported by approximately 30-40% in both groups. Men in the RP group consistently reported more leakage, impaired erection and libido, and fewer obstructive voiding symptoms. For men in the WW group, distress related to erectile symptoms increased gradually over time. Symptom burden and distress at baseline was predictive of long-term outlook. Conclusions: Cancer negatively influenced daily activities among almost all men in both treatment groups; health-related distress was common. Trade-offs exist between physiologic symptoms, highlighting the importance of tailored treatment decision-making. Men who are likely to experience profound long-term distress can be identified early in disease management.
机译：背景：需要列举前列腺癌（PCa）治疗后的生理和情绪症状动态的研究，以指导治疗策略。然而，对于比较治疗组的观察性研究来说，克服患者的选择力是一个巨大的挑战。目的：比较随机分为局限性前列腺切除术（RP）或观察性等待（WW）和纵向随访的局部PCa男性的症状负担和困扰模式。设计，地点和参与者：瑞典最大的三个北欧斯堪的纳维亚前列腺癌第4组随机试验中心进行了一项纵向研究，通过每6个月邮寄调查表2年，然后通过邮寄问卷调查来评估多个心理和身体领域的症状和痛苦。每年至8年的随访。干预：RP与WW相比。成果测量和统计分析：在基线时寄出问卷，然后在随访期间重复询问有关身体和精神症状的问题。生活质量的每项分析均基于二项式响应广义线性混合模型中研究的结果二分（是与否）。结果与局限性：在347名随机分组的男性中，有272名在8年的随访期内完成了至少五份问卷。几乎所有人都报告说PCa对日常活动和人际关系产生了负面影响。两组的健康相关困扰，忧虑，情绪低落和失眠的发生率均持续约占30-40％。 RP组的男性持续报告更多的渗漏，勃起和性欲减退，以及较少的阻塞性排尿症状。对于WW组的男性，与勃起症状相关的困扰随着时间的推移逐渐增加。基线时的症状负担和困扰可预测长期前景。结论：在两个治疗组中，几乎所有男性的癌症都对日常活动产生负面影响。与健康有关的困扰很普遍。生理症状之间存在取舍，这突出了定制治疗决策的重要性。可以在疾病管理的早期就识别出可能长期遭受严重困扰的男性。

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