最新報導 : 預測攝護腺癌病人的性功能

Predicting Sex Life After Prostate Cancer

By TARA PARKER-POPE

預測攝護腺癌病人的性功能

塔拉帕克波普報導

Treatments for prostate cancer take a significant toll on male potency, leaving a surprisingly high percentage of men unable to have a normal sex life, new research shows.

新的研究顯示：治療攝護腺癌嚴重影響勃起功能，有一大部份的人嚴重到無法維持正常的性生活。

The findings, based on a study of more than 1,000 men treated for prostate cancer at multiple medical centers, show that whether a man is able to achieve adequate erections after treatment for prostate cancer varies greatly depending on a number of individual variables, including his age, the extent of his cancer and the quality of his sex life before treatment.

根據一項跨醫學中心研究1000多名男性接受攝護腺癌治療的結果顯示，一個人在攝護腺癌治療後能否維持良好的勃起功能取決於他的年齡，癌症侵犯程度以及治療前性生活的品質。

Over all, fewer than half of the men who reported good sexual function before cancer had managed to regain it two years after treatment. But the chances of sexual recovery varied widely. After two years, some men had less than a 10 percent chance of achieving adequate erections after treatment, whereas others had a 70 percent or greater chance of a relatively normal sex life.

一般來說，不到一半的人在治療二年後擁有良好的性功能．然而性功能恢復的機會因人而異，有些人只有不到 10％的機會，有些人則有70％或更高機會在治療兩年後擁有正常的性生活。

 The results were not encouraging, but for the first time offer men a more personalized model for predicting sexual recovery after cancer treatment.

這樣的結果並不令人鼓舞，但這是首次提供個人化模組來預測癌症治療後性功能恢復的研究。

 Cancer experts say the data, published Tuesday in The Journal of the American Medical Association, are sorely needed, in light of marketing efforts that are aimed at wooing men toward particular types of treatment but that often leave patients with unrealistic expectations. Many men report feeling shocked and depressed when their sex lives fail to return to normal after treatment.

癌症專家說，週二在美國醫學協會雜誌公佈的數據是迫切需要的，因為目前所推出的各種不同治療方式都因行銷之故給予人們不實際的期望。許多男人感到震驚和沮喪，當他們接受治療後性生活無法回復正常。

“I think being transparent about what the pros and cons are, the reality — that’s important,’’ said Dr. Martin G. Sanda, senior author on the research and director of the prostate care center at Beth Israel Deaconess Medical Center in Boston. “For any of the treatments for prostate cancer, it would be misleading to tell someone they have a 100 percent chance of sexual recovery, or even a 95 percent chance. It’s easier for a couple to face that and deal with that if they are expecting it than if they were oversold and told there weren’t going to be any issues.”

“我認為傳達事實，無論優缺點，是重要的．”馬丁博士G.散打，本研究的資深作者及波士頓貝斯以色列女執事醫療中心的攝護腺保健中心主任。“關於攝護腺癌的任何治療，告訴病人有９５－１００％機會恢復性功能是誤導病人。一對夫婦如果沒有被誤導，了解到可能面對的問題，他們將比較能夠正面處理及解決。”

 The study evaluated sexual function among men at nine academic medical centers who had undergone one of three treatments for prostate cancer: surgical removal of the prostate; radiation therapy; or brachytherapy, which uses radioactive seed implants.

該研究評估男性性功能，對象為九個學術醫療中心裏曾接受以下三項攝護腺癌治療其中之一的病患：攝護腺切除手術，放射治療，或近接放射治療（即放射核種植入術）。

Over all, just 35 percent of men in the surgery group, 37 percent of men in the radiation group and 43 percent of men in the brachytherapy group were able to have sexual intercourse two years after treatment.

 總而言之，只有35％的手術組男性，37％的放射治療組男性，和43％的近接放射治療組男性在治療後兩年能夠正常性交。

 Because the men weren’t randomly assigned to a treatment, the data don’t demonstrate whether one treatment is better than another. For instance, men who opt for brachytherapy are typically younger and healthier than men who undergo radiation treatment, so the results can’t be compared.

因為不是隨機分配治療，數據無法顯示任一種治療是否比另一種更好。舉例來說，選擇近接放射治療的男性通常比放射治療的男性年輕及健康，因此結果沒有可比性。

 However, the researchers were able to determine which variables are most important for predicting a man’s erectile function after treatment. In all three treatment groups, the quality of a man’s erections before treatment — determined using a questionnaire about his sex life — helped predict his sexual recovery. Among surgical patients, a man’s age and his P.S.A. score, which measures prostate specific antigen, and whether he had nerve-sparing surgery also helped predict his chances of resuming a normal sex life. For men undergoing radiation treatment, those who had not also undergone hormone therapy were more likely to regain erectile function two years after treatment. Among men who had brachytherapy, a younger age and lower body weight helped predict a better recovery compared with men who were older or obese.

不過研究人員能夠確定哪些變數是預測一個人治療後勃起功能最重要的因子。以三種治療方式共同的因子而言，治療前的勃起功能－依一份關於術前性生活的問卷評估－能預測他​​的恢復情形。手術組病人中，年齡，PSA指數，以及手術是否保留神經保留都有助於預測恢復機率。放射治療組病人中，沒有接受荷爾蒙治療的人更容易恢復勃起功能。近接放射治療組中，年齡小體重輕的病人將比老年或肥胖的男性有更好的恢復。

 One limit of the study is that it followed the men for only two years. Men who undergo radiation and brachytherapy may experience a decline in erectile function two or more years after treatment, whereas men who undergo surgery may experience improvement.

研究的缺陷之一是，它只追踪病人兩年。接受放射治療及近接放射治療的男性其勃起功能將可能進一步下降，反之接受手術的男性則可能改善。

 Dr. Sanda said the data would allow doctors to take a more personalized approach as they talk to patients about the risks of a given treatment and counsel them about the benefits of drugs and other therapies that can improve erectile function.

散打博士表示，這些數據將讓醫生採取更加個人化的方式來跟病人談論治療的風險，並進一步提供關於改善勃起功能藥物或治療方法的諮詢。

“By and large, a lot of what we counsel men has been based on generalized average numbers,’’ said Dr. Sanda. “This really creates a more concrete metric as to what patients might expect.”

散打博士說：“總的來說，我們的建議多半根據一般性的統計數字，而這真的讓病人的期待更加現實而具體。”