Expectant management of prostate cancer with curative intent: An update of the Johns Hopkins experience
Expectant management of prostate cancer with curative intent: An update of the Johns Hopkins experience
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DOI：
10.1016/j.juro.2007.08.039
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发表时间：
2007-12-01
影响因子：
6.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Carter, H. Ballentine;Kettermann, Anna;Epstein, Jonathan I.
目的：我们更新了我们对T1c期前列腺癌患者的期待治疗策略，并评估了疾病干预的预测因素。材料和方法：407名男性，中位年龄65.7岁(45.8~81.5岁)，T1c期(99.8%)或T2a期(0.2%)，根据活检结果和前列腺特异性抗原密度，怀疑患有小体积前列腺癌。如果不良的后续针刺活检结果提示疾病进展(Gleason分型4或5，多于2个癌症活检核心或任何核心肿瘤累及超过50%)，则建议治疗。结果：407例男性患者中，239例(59%)仍处于积极监测状态，中位随访时间为3.4年(0.43~12.5)，103例(25%)在确诊后平均2.2年(0.96~7.39)接受治疗干预，65例(16%)失去随访(12例)、退出计划(45例)或死于前列腺癌以外的其他原因(8例)。诊断年龄较大(p=0.011)和诊断日期较早(p=0.001)与治疗干预显著相关。结论：认识到前列腺癌的过度治疗很普遍，特别是在老年患者中，仔细选择和监测可能存在小体积、低级别疾病的老年男性可能是积极治疗ALL的合理替代方案。
Purpose: We updated our experience with a strategy of expectant treatment for men with stage T1c prostate cancer and evaluated predictors of disease intervention.Materials and Methods: A total of 407 men with a median age of 65.7 years (range 45.8 to 81.5) with stage T1c (99.8%) or T2a (0.2%) prostate cancer suspected of harboring small volume prostate cancer based on needle biopsy findings and prostate specific antigen density have been followed in a prospective, longitudinal surveillance program with a median followup of 2.8 years (range 0.4 to 12.5). A recommendation for treatment was made if disease progression was suggested by unfavorable followup needle biopsy findings (Gleason pattern 4 or 5, greater than 2 biopsy cores with cancer or greater than 50% involvement of any core with cancer). Cox proportional hazards regression was used to evaluate the affect of multiple covariates on the outcome of curative intervention.Results: Of 407 men 239 (59%) men remained on active surveillance at a median followup of 3.4 years (range 0.43 to 12.5), 103 (25%) underwent curative intervention at a median of 2.2 years after diagnosis (range 0.96 to 7.39) and 65 (16%) were either lost to followup (12), withdrew from the program (45), or died of causes other than prostate cancer (8). Older age at diagnosis (p = 0.011) and an earlier date of diagnosis (p = 0.001) were significantly associated with curative intervention.Conclusions: Recognizing that over treatment of prostate cancer is prevalent, especially among elderly patients, a program of careful selection and monitoring of older men who are likely to harbor small volume, low grade disease may be a rational alternative to the active treatment of all.