目的:目前对局限性前列腺癌(PCa)的治疗选择包括根治性前列腺切除术(RP),放射治疗(RT),主动监测(AS)。尽管肿瘤结果相当,在患者报告的结局指标(PROM)和患者报告的经验指标(PREM)方面,仍缺乏证据证明它们的相对有效性.我们对比较PROM和PREM的研究进行了系统回顾,在所有推荐的本地化PCa管理选项之后(RP,RT,AS).
方法:在MEDLINE中进行了文献检索,EMBASE,和CochraneCENTRAL数据库符合欧洲泌尿外科协会指南办公室的建议以及系统审查和荟萃分析声明的首选报告项目。包括所有报告PROM和/或PREM以比较RP与RT与AS的前瞻性临床试验。使用叙述性综合来总结综述结果。由于现有研究的异质性和局限性,没有进行定量合成。
■我们的研究结果表明,RP主要影响尿失禁和性功能,与其他治疗相比,排尿症状效果更好。RT与肠功能和排尿症状的更大损害相关。这些治疗方法均未对精神或身体生活质量产生重大影响。只有少数研究报告了PREM,所有模式的决策后悔率都很高(高达23%)。
结论:所有推荐的局部PCa治疗对PROM和PREM都有影响,但对于不同的领域和不同的严重性。我们在PROM收集中发现了显著的异质性,因此,在现实世界的实践和临床试验的标准化是必要的。只有少数研究报告了PREM,强调一个未满足的需求,应该在未来的研究中探讨。
结果:我们回顾了手术切除前列腺后患者报告的结果和经验的差异,放射治疗,或者主动监测前列腺癌.我们发现对泌尿的影响不同,肠,和治疗中的性功能,但精神或身体生活质量没有区别。我们的结果可以帮助医生和前列腺癌患者共同决策。
OBJECTIVE: Current management options for localized prostate cancer (PCa) include radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS). Despite comparable oncological outcomes, there is still lack of evidence on their comparative effectiveness in terms of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). We conducted a systematic review of studies comparing PROMs and PREMs after all recommended management options for localized PCa (RP, RT, AS).
METHODS: A literature search was performed in the MEDLINE, EMBASE, and Cochrane CENTRAL databases in accordance with recommendations from the European Association of Urology Guidelines Office and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All prospective clinical trials reporting PROMs and/or PREMs for comparisons of RP versus RT versus AS were included. A narrative synthesis was used to summarize the review findings. No quantitative synthesis was performed because of the heterogeneity and limitations of the studies available.
UNASSIGNED: Our findings reveal that RP mostly affects urinary continence and sexual function, with better results for voiding symptoms in comparison to other treatments. RT was associated with greater impairment of bowel function and voiding symptoms. None of the treatments had a significant impact on mental or physical quality of life. Only a few studies reported PREMs, with a high rate of decision regret for all modalities (up to 23%).
CONCLUSIONS: All recommended treatments for localized PCa have an impact on PROMs and PREMs, but for different domains and with differing severity. We found significant heterogeneity in PROM collection, so standardization in real-world practice and clinical trials is warranted. Only a few studies have reported PREMs, highlighting an unmet need that should be explored in future studies.
RESULTS: We reviewed differences in patient reports of their outcomes and experiences after surgical prostate removal, radiotherapy, or active surveillance for prostate cancer. We found differences in the effects on urinary, bowel, and sexual functions among the treatments, but no difference for mental or physical quality of life. Our results can help doctors and prostate cancer patients in shared decision-making.