背景：
在初次診斷攝護腺癌的病人中，侷限性攝護腺癌（localized prostate cancer）佔大多數。除了疾病控制的成效外，接受癌症治療後的生活品質（Quality of life）情況亦是侷限性攝護腺癌初步治療選擇的重要考量因素之一。目前侷限性攝護腺癌生活品質的研究多著重於癌症特定 (cancer specific) 的生活品質，而非一般性 (generic) 的生活品質。除此之外，生活品質評估的時間點多屬特定時間點而非連續性的測量。本研究使用台灣簡明版世界衛生組織生活品質問卷 (World Health Organization. Quality of Life-BREF Taiwan Version) 來評估在不同治療方式後侷限性攝護腺癌患者一般性生活品質的情況，並建構病人治療後生活品質連續的動態變化。

研究方法：
從2013年至2018年，我們前瞻性邀請成大醫院泌尿科門診部接受單一種癌症治療侷限性攝護腺癌的患者接受台灣簡明版世界衛生組織生活品質問卷的評估。同一位病人，可在治療後不同時間點接受重複的生活品質評估。為減少不同治療對生活品質的干擾，患者於追蹤期間接受第兩種侷限性攝護腺癌治療時的被予以設限。我們使用混合線性模式來處理重複測量的資料並使用核平滑化方法來比較不同癌症治療後病人生活品質的動態連續變化。

結果：
本實驗共收納196名侷限性攝護腺患者，並實施了498次評估。治療後生活品質的動態連續軌跡顯示，接受體外放射治療的患者的在治療的早期的身理狀況，工作能力和環境資源如每日信息、交通運輸都表現較差，但與其他治療相比，則在治療早期有較好的疼痛狀況。接受積極監視的患者在追蹤期間的前半段有較好的被尊重感，但與根除性攝護腺切除手術相比，它們同時也遭受了較多負面的感受。這些生活品動態軌跡的差異在追蹤的後期階段都逐漸式微了。我們發現家庭收入較低的患者在台灣簡明版世界衛生組織生活品質問卷的4大範疇和各範疇的相關子題均顯示出統計學上顯著較低的分數，而有焦慮和/或糖尿病的患者似乎在生理範疇和相關子題受到了影響。在以混合線性模式控制了這些決定因素之後，與根除性攝護腺切除手術或體外攝護腺放射治療相比，接受積極監視的患者在治療後一年內的生理和社會關係範疇以及上述範疇的相關子題有較高的生活品質分數。但不同癌症治療在治療超過一年後的生活品質表現並無明顯統計上的差異。

結論：
儘管侷限性攝護腺癌患者接受積極監視的處理在治療後第一年內的一般性生活品質評分在本研究部分表現較高，我們仍需要更多的更大樣本數及更長追蹤時間的研究來印證我們的研究結果。

Background: Among patients who initially diagnosed prostate cancer, localized prostate cancer accounted for the majority. In addition to the effectiveness of disease control, the quality of life (QoL) after cancer treatment is also one of the important considerations for the initial treatment selection of localized prostate cancer. At present, researches on the QoL of localized prostate cancer focus mainly on cancer specific QoL rather than generic QoL. Most of them assess the QoL at certain specific time points rather than continuous measurements. This study uses the Taiwan Version of World Health Organization Quality of Life-brief version questionnaire (WHOQOL-BREF) to evaluate the generic QoL of patients with localized prostate cancer after different treatment modalities and construct continuous dynamic changes of the QoL after treatment.

Material and method: From 2013 to 2018, we prospectively invited patients with localized prostate cancer at urology outpatient department of National Cheng Kung University Hospital to fill the WHOQOL-BREF. The same patient can receive repeated QoL assessments at different time points after treatment. In order to reduce the interference of different treatments on the QoL, patients with localized prostate cancer who were censored when they received the subsequent cancer treatment. Mixed effect model was used for repeated QoL assessment and kernel smoother method was used to construct the dynamic changes of QoL among patients after different cancer treatments.

Results: A total of 196 patients with localized prostate cancer were enrolled, and 498 QoL assessments were performed. The QoL trajectories show patients received radiotherapy had poor physical health domain, work capacity and poor environment resource as less daily information and transportation initially but better of pain in the early phase comparing to others. Patients under Active surveillance or observation had better feelings of respect in the early half of follow up. However, comparing to radical prostatectomy they also suffered a bit negative feeling from then on. These difference all diminished at late phase of follow up. Patients with lower household income showed significantly lower scores in all four domains and the related facets of the WHOQOL-BREF, while patients having comorbidity of anxiety and / or diabetes seems to be affected on physical health domain and related facets. After controlling the manor determinants in the mixed effect model, patients under active surveillance or observation have higher QoL scores over physical health and social relationships domain and the related facets of these domains within one year after treatment comparing to radical prostatectomy or radiotherapy. There is no significant difference in the QoL beyond one year among different cancer treatments.

Conclusion: Although patients with localized prostate cancer under active surveillance or observation generally have a higher general QoL score in some aspects within first year after treatment in this study, we still need more larger samples and longer follow-up studies to confirm our research results.

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