Patient-reported Outcome Measures and Experience Measures After Active Surveillance Versus Radiation Therapy Versus Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies.

IF 8.3 1区 医学 Q1 ONCOLOGY
European urology oncology Pub Date : 2024-12-01 Epub Date: 2024-05-29 DOI:10.1016/j.euo.2024.05.008
Andrea Alberti, Rossella Nicoletti, Daniele Castellani, Yuhong Yuan, Martina Maggi, Edoardo Dibilio, Giulio Raffaele Resta, Pantelis Makrides, Francesco Sessa, Arcangelo Sebastianelli, Sergio Serni, Mauro Gacci, Cosimo De Nunzio, Jeremy Y C Teoh, Riccardo Campi
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引用次数: 0

Abstract

Background and 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.

Key findings and limitations: 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 and clinical implications: 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.

Patient summary: 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.

前列腺癌主动监测、放射治疗和根治性前列腺切除术后的患者报告结果测量和体验测量:前瞻性比较研究的系统回顾。
背景和目的:目前治疗局部前列腺癌(PCa)的方法包括根治性前列腺切除术(RP)、放射治疗(RT)和主动监测(AS)。尽管它们的肿瘤治疗效果相当,但在患者报告的结果测量指标(PROMs)和患者报告的体验测量指标(PREMs)方面,仍缺乏有关其比较效果的证据。我们对所有推荐的局部 PCa 治疗方案(RP、RT、AS)后的 PROMs 和 PREMs 比较研究进行了系统性回顾:根据欧洲泌尿外科协会指南办公室的建议和《系统综述和元分析首选报告项目》声明,我们在 MEDLINE、EMBASE 和 Cochrane CENTRAL 数据库中进行了文献检索。所有报告 PROMs 和/或 PREMs 的前瞻性临床试验均纳入 RP 与 RT 与 AS 的比较。采用叙事综合法对综述结果进行总结。由于现有研究的异质性和局限性,未进行定量综合:我们的研究结果表明,RP主要影响尿失禁和性功能,与其他治疗方法相比,RP对排尿症状的效果更好。RT对排便功能和排尿症状的影响更大。所有治疗方法都不会对精神或身体的生活质量产生重大影响。只有少数研究报告了PREMs,所有方式的决策后悔率都很高(高达23%):结论和临床意义:所有推荐的局部 PCa 治疗方法都会对 PROMs 和 PREMs 产生影响,但影响的领域和严重程度各不相同。我们发现PROM的收集存在很大的异质性,因此需要在实际实践和临床试验中进行标准化。患者摘要:我们回顾了前列腺癌手术切除、放疗或主动监测后患者对其结果和经历的报告差异。我们发现不同治疗方法对排尿、排便和性功能的影响存在差异,但对精神或身体生活质量的影响没有差异。我们的研究结果有助于医生和前列腺癌患者共同决策。
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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
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