Active surveillance for prostate cancers detected in three subsequent rounds of a screening trial:: Characteristics, PSA doubling times, and outcome
Active surveillance for prostate cancers detected in three subsequent rounds of a screening trial:: Characteristics, PSA doubling times, and outcome
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DOI：
10.1016/j.eururo.2006.11.053
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发表时间：
2007-05-01
期刊：
影响因子：
23.4
通讯作者：
Schroder, Fritz H.
中科院分区：
文献类型：
--
作者：
Roemeling, Stijn;Roobol, Monique J.;Schroder, Fritz H.
目的：研究主动监测作为一个重要的前列腺癌患者的管理选项，这些患者在没有筛查的情况下不会被诊断。患者和方法：我们分析了在欧洲前列腺癌筛查随机研究(ERSPC)鹿特丹部分筛查到的所有主动监测男性的基线特征和结果参数。招募和监测男性并不以程序为指导，而是取决于患者和他们的医生的个人决定。结果：1993年至2006年筛查发现278名男性，实施了主动监测。确诊时年龄中位数为69.8岁(25~75岁；66.1~72.8岁)，PSA中位数为3.6 ng/ml(25~75岁；3.1~4.8岁)，临床分期为T1c期220例(79.1%)，T2期58例(20.9%)。在中位数3.4年的随访中，103名男性(44.2%)的PSA倍增时间为负(即半衰期)或超过10年。在重新筛查时被发现的男性明显更有可能进行积极的监测，他们具有更多有益的特征。选择延期治疗82例(29.0%)。8年后总存活率为89%；病因特定存活率为100%。结论：这份报告显示了积极监测筛查男性的有益结果，尽管是初步的。如果在重复筛查中发现这种疾病，男性更有可能受到积极的监测。该报告还显示，有很大一部分男性的PSA倍增时间延长，尽管这一参数的值在未经治疗的男性中尚未确定。(C)2006年欧洲泌尿外科协会。爱思唯尔出版，版权所有。
Objectives: To study active surveillance as a management option for the important number of prostate cancer patients who would not have been diagnosed in the absence of screening.Patients and methods: We analyzed baseline characteristics and outcome parameters of all men on active surveillance who were screen-detected in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Recruitment and surveillance of men were not guided by a protocol but depended on individual decisions of patients and their physicians.Results: Active surveillance was applied in 278 men detected by screening from 1993 to 2006. At diagnosis, their median age was 69.8 yr (25-75p; 66.1-72.8); median PSA 3.6 ng/ml (25-75p; 3.1-4.8), and the clinical stage was T1c in 220 (79.1%) and T2 in 58 (20.9%). During the follow-up of median 3.4 yr, 103 men (44.2%) had a PSA doubling time that was negative (ie, half-life) or longer than 10 yr. Men detected at rescreening were significantly more likely to be on active surveillance, and they had more beneficial characteristics. Deferred treatment was elected in 82 cases (29.0%). Overall survival was 89% after 8 yr; the cause-specific survival was 100%.Conclusions: This report shows a beneficial, although preliminary, outcome of screen-detected men managed on active surveillance. Men were more likely to be on active surveillance if the disease was detected at repeated screening. The report also shows that an important proportion of men have prolonged PSA doubling times, although the value of this parameter has not been established in untreated men. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.