Lionne Venderbos 博士

　　本次会议我们报告了在前列腺癌主动监测方面的最新研究。研究比较了主动监测、手术治疗、放疗对前列腺癌患者生活质量的影响，并且与没有前列腺癌的正常人群进行了比较。研究发现主动监测组与前列腺根治术组相比，患者尿失禁发生率更低，具有更好的尿控和性功能；与放疗组相比，具有更好的性功能。这正是研究者所期盼的，即无需侵入性治疗，仅采用主动监测，随访PSA，必要时进行前列腺活检和MRI。与正常人群相比，主动监测组具有非常相近的生活质量。因此，经过中位期为6.5年的随访，主动监测组患者接受了这一处理策略。他们学会了与体内低危的前列腺癌共处，继续自己的生活。

　　本研究率先比较了不同处理方式对前列腺癌患者生活质量的影响，并与无前列腺癌的正常人群进行了对比。因此，对所有类型的人群均进行了研究。此外，还在阿姆斯特丹进行了PRIAS研究，这是一项关于主动监测的大规模的临床研究。因为进行随访的时间长，所以这是第一个完成为期5~10年有关生活质量队列的随访研究。我们也将这部分研究结果加入了进来。这是第一个对治疗组、正常对照组和主动监测组生活质量进行对比的研究报告。

　　改善患者生活质量的研究很有意义。去年12月我完成了我的毕业论文，也是关于低危前列腺癌患者生活质量的研究。我对本领域包括风险预估、筛选适合进行主动监测的患者并进一步完善主动监测的纳入标准方面的研究很感兴趣。

研究摘要

949: Long-term quality of life outcomes after active surveillance or curative treatment for prostate cancer

Introduction & Objectives: Long-term， i.e. 5-10 year， quality of life (QoL)?data in men on active surveillance (AS) is scarce. We compared long-term QoL?between men on AS， men who underwent radical prostatectomy (RP) or radiotherapy?(RT)， and a reference group of men without prostate cancer (PCa).

Material & Methods: Four groups were invited to fill in a one-time?QoL questionnaire; (1) men following a structured AS protocol (PRIAS)， (2) men?who underwent RP between 2007-2011 in the context of a screening study (ERSPC?Rotterdam); (3) men who underwent RT at the Erasmus Medical Center， Rotterdam，?and (4) a reference group of men without prostate cancer who were age matched?to the AS， RP， and RT groups. Follow-up in treatment groups was ≥ 4 years. The?questionnaire addressed general health (SF-12)， respondents’ self-rated health?(EQ-VAS)， generic anxiety (STAI-6)， PCa-related anxiety (MAX-PC， for AS only)，?and urinary， bowel and sexual function (EPIC). Statistical significance (p≤0.05) and clinical relevance (Minimal Important Difference (MID)， ≥0.5 SD) of?differences in questionnaire scores between groups were assessed.

Results: Response rates for the AS， RP， RT and reference group amounted to 73%?(121/166)， 67% (74/111)， 67%(232/348)， and 75% (204/273) respectively. Median?ages of men ranged from 73 to 76. Men on AS were more often highly educated?(table 1). More men on AS were still employed， which is likely related to age.?The AS group reported better urinary function (100 vs. 83， p= <0.001)， less urinary?incontinence (100 vs. 75， p= <0.001) and better sexual function (44 vs. 6，?p= <0.001) than men who underwent RP. These differences were also clinically relevant. When comparing AS to RT a statistically significant and clinically?relevant difference in favor of the AS group was seen regarding sexual function?(44 vs. 18， p= 0.001). The QoL of men on AS was very similar to that of men without PCa.

ConclusionsIn： the long-term， QoL of men on AS was better?than that of men who underwent direct active treatment and similar to that of?men without PCa. Furthermore， anxiety-levels?are low for men that choose to follow an AS strategy for a median of 6.5 years.?This is important information for urologists and for newly diagnosed men with low-risk PCa， facing a decision about their initial therapy.