三种治疗方案对局限性前列腺癌患者性功能以及尿路梗阻和刺激的影响

Influence of three treatment plans on sexual function,urinary tract obstruction and stimulus of patients with localized prostate cancer

目的比较根治性前列腺切除术(RP)、外照射放疗(EBRT)与近距离放疗(BT)对局限性前列腺癌患者性功能以及尿路梗阻和刺激的影响。方法筛选某院2010年1月至2015年1月收治入院的前列腺癌患者240例,根据治疗意愿将患者分成3组,其中EBRT组63例,BT组46例,RP组131例。收集患者的人口统计学资料,前列腺特异性抗原(PSA),Gleason评分,癌症分期,共存疾病指数(ICED)评分以及SF-12评分。比较治疗前和治疗后3、12和24个月时,不同治疗方案对性功能以及尿路梗阻和刺激的影响。结果 3组患者在民族、教育水平、婚姻状态、ICED以及SF-12评分差异无统计学意义(P>0.05)。与RP组或BT组相比较,EBRT组年龄较大,治疗前PSA水平和Gleason评分较高,临床分期较高(P<0.05)。治疗前,3组性功能障碍评分比较差异均无统计学意义(均P>0.05),开始治疗后,各组患者性功能障碍均显著高于治疗前(均P<0.05)。在治疗后3、12和24个月时,RP组性功能障碍评分明显高于接受BT组和EBRT组患者,但EBRT组与BT组相比较差异无统计学意义(P>0.05)。治疗前,3组患者的尿路梗阻和刺激评分比较差异无统计学意义(均P>0.05),治疗后3个月时,3组患者的尿路梗阻和刺激评分均明显升高(均P<0.05);治疗后12和24个月时,3组患者的尿路梗阻和刺激评分均有所降低(P<0.05),RP组最低,BT组最高(P<0.05)。结论 EBRT、BT和RP均可影响前列腺癌患者的生活质量,EBRT对性功能的影响较小,BT可引起明显的尿路梗阻和刺激症状,RP可明显改善尿路梗阻和刺激症状,但严重影响性功能。

Objective To compare the influence of radical prostatectomy（RP）,external radiation therapy（EBRT） and brachytherapy（BT） on the sexual function,urinary tract obstruction and stimulus of patients with localized prostate cancer.Methods 240 patients with prostatic cancer admitted in a hospital from January 2010 to January 2015 were selected and divided into three groups in accordance with their treatment will,with 63 cases in the EBRT group,46 cases in the BT group and 131 cases in the RP group.Demographic data,prostate specific antigen（PSA）,Gleason score,cancer staging,coexistence disease index（ICED） score and SF-12 score of patients were collected.The effects of three treatment plans on the sexual function,urinary tract obstruction and stimulus were compared before the treatment and 3 months,12 months and 24 months after the treatment.Results Three groups of patients showed no statistical significance on nationality,education level,marriage status,ICED and SF-12 scores（P〉0.05）.Compared with RP and BT groups,patients in EBRT group were older and had higher PSA level and Gleason scores before the treatment and were of higher clinical stage.The difference showed statistical significance（P〈0.05）.Before the treatment,sexual dysfunction scores of the three groups showed no statistical significance（P〉0.05）.After treatment,sexual dysfunction scores of the three groups were all significantly higher than those before the treatment（P〈0.05）.3 months,12 months and 24 months after the treatment,the sexual dysfunction scores of the RP group were significantly higher those of the BT and EBRT groups but the difference between EBRT and BT group was of no statistical significance（P〉0.05）.Before treatment,urinary tract obstruction and stimulus scores of the three groups showed no statistical significance（P〉0.05）.3 months after the treatment,urinary tract obstruction and stimulus scores of the three groups increased significantly and the difference was of statistical significance（P〈0.05）.12 months and 24 months after the treatment,urinary tract obstruction and stimulus scores of the three groups decreased（P〈0.05）,with the score of the RP group being the lowest and BT highest（P〈0.05）.Conclusion EBRT,BT and RP all influence life quality of patients with prostatic cancer.EBRT had the least influence on sexual function while BT could cause obvious urinary tract obstruction and stimulus symptoms.RP could significantly improve urinary tract obstruction and stimulus symptoms but severely influence sexual function of patients.