Patienten vor radikaler Prostatektomie oder Brachytherapie : ein epidemiologischer Vergleich

INTRODUCTION & OBJECTIVE: With about 144000 cases per year prostate cancer (PC) is the second important cancer of men in Europe. There are about 56000 deaths because of PC every year in the European Union. Treatment options for the localised disease are the radical prostatectomy (RP) and the brachytherapy (BT). The BT can be administered as “low dose rate brachytherapy” (LDR) or “high dose rate brachytherapy” (HDR). In the years between January 1999 and November 2004 653 patients with localised prostate cancer were treated at the department of urology at “Universitätsklinikum Aachen”. Among them there were 422 treated with RP (64.6%) and 231 with BT (35.4%). The RP-group consisted of 332 men treated with RPP (78.7%) and 90 treated with RRP (21.3%). In the BT-group there were 117 men with LDR (50.6%) and 114 with HDR (49.4%). Clinical, demographic and socioeconomic data as well as data about continence status and health related QoL were collected by a team of independent investigators in order to compare baseline data of the named treatment groups. METHODS: In a relational data base epidemiologic as well as clinical data were collected. All patients eligible for treatment got a seven-page questionnaire including 93 questions about urine (ICS male questionnaire for urinary symptoms) and stool continence (Kelly Score Questionnaire), questions concerning erectile function and the EORTC QLQ-C30 quality of life questionnaire. We compared all groups using statistical tests. RESULTS: Clinical data of all patients could be evaluated. The questionnaire was completed by 503 men (77.0%) including 321 patients (76.1%) of the RP group and 182 of the BT-group (78.8%). Data of 503 men could be analyzed containing the data of 321 patients before undergoing RP (63.8%) - 271 of the RPP (84.4%) and 50 of the RRP-group – and 182 patients before BT (36.2%) – 87 men of the HDR-group (47.8%) and 95 of the LDR-group (52.2%). Patients before undergoing RP were statistical significantly younger than those undergoing BT (p=0.0001) and the rate of retired men was lower (p=0.0014). There were the same findings comparing the younger LDR-group with men of the HDR-group (p=0.0149 and p=0.0018 respectively). The staging parameters PSA und gleason score were better in the RP-group than in the BT-group (p< 0.001 and p< 0.0001) and they were better in the LDR-group than under men before undergoing HDR (p<0,0001 and p = 0,0058). Erectile dysfunction was more often detected under men of the BT-group than among the RP-group (p<0.001) and more often under men before HDR than before LDR (p=0.0455). We did not find statistical significant differences in “bowel problems” Men before a treatment with HDR suffered slightly more from “lower urinary tract symptoms” (LUTS) than patients of the RP-group (p=0.0481). Physical function was better under men before undergoing RP compared with the BT-group (p= 0.0002) and it was better under patients before undergoing LDR than before the group of men asked before a treatment with HDR (p=0.0134).CONCLUSIONS: We found statistical significant differences in age, physical function and erectile dysfunction with the patients in the RP group being the younger and fitter group with less erectile dysfunction or LUTS. Bowel symptoms were quite prevalent. The big differences between the data of the HDR- and the LDR-group prove the necessity of separated evaluation of patients who have bee treated with BT. In our study patients with a good erectile function have been treated preferentially with RP disregarding the possible side effects of an erectile dysfunction. With regard to the results of studies that analyzed patients after a treatment of PC with BT or RP the higher rates of erectile dysfunction and LUTS among our patients before undergoing BT and the quite equal rate of bowel dysfunction under all our patients should be considered. These findings underline the necessity of prospective data thoroughly checked for confounding variables when judging complications of different treatment forms for localised prostate cancer.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2007

Author dc:creator

• Stefka, Daniel Stephan

Contributors dc:contributor

• Jakse, Gerhard

• info:eu-repo/classification/ddc/610
• Prostatakrebs
• Prostatektomie
• Brachytherapie
• Epidemiologie
• Harninkontinenz
• Darminkontinenz
• Impotenz
• Lebensqualität
• Medizin
• prostate cancer
• brachytherapy
• radical prostatectomy
• impotence
• urinary incontinence
• bowel dysfunction

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-124224%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:62697