Active surveillance in young patients with prostate cancer: the unanswered question.
Active surveillance in young patients with prostate cancer: the unanswered question.
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对年轻前列腺癌患者的主动监测：尚未解答的问题。
DOI：
10.1200/jco.2009.27.3383
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发表时间：
2010
影响因子：
45.3
通讯作者：
M. Maffezzini
中科院分区：
文献类型：
--
作者：
F. Campodonico;M. Maffezzini
致编辑：在对 450 名低风险前列腺癌患者进行主动监测的长期随访研究中，Klotz 等人将 30% 的患者重新分类为高风险，因此需要明确的治疗（根治性前列腺切除术或放射治疗）。提供延期治疗的关键决定是基于再活检时的前列腺特异性抗原动力学和组织学。尽管在中位随访时间为 6.8 年的情况下，继续监测的患者与接受根治性治疗的患者之间的总生存率没有差异，但正如作者指出的那样，对于重新分类为进展且被转介至延迟治疗的男性的长期结果仍然存在一些疑问。考虑到患者的中位年龄为 70.3 岁，并且正在进行的前列腺癌研究，例如欧洲前列腺癌研究国际：主动监测 (PRIAS) 项目，提供了包括所有患者的主动监测，不确定性立即出现。加拿大的研究报告称，患者根据维也纳列线图方案接受了初步活检，根据患者年龄和腺体体积进行了 8 至 14 个核心活检。然而，该研究于 1995 年 11 月开始，维也纳列线图于 2005 年发表。1998 年之前，没有研究报告扩展的前列腺活检方案，该方案至少有 8 个核心（六分仪加两个侧面活检）。因此，在研究开始时和之后招募的患者中，该队列在癌症风险定义的准确性方面可能并不均匀。我们认为，更准确的初始活检计划（维也纳列线图应该是最佳的）可以在阳性核心数量和格里森评分的可靠性方面提高癌症风险较高患者的检测准确性，最重要的是，确定适合监测的真正低风险患者。
TO THE EDITOR: In their long-term follow-up study on a cohort of 450 patients with low-risk prostate cancer managed with active surveillance, Klotz et al reclassified 30% of patients as higher risk, thus requiring definitive therapy (radical prostatectomy or radiotherapy). The critical decision to offer deferred treatment is based on prostate-specific antigen kinetics and histology at rebiopsy. Notwithstanding no difference noted in overall survival between patients who remained on surveillance and those who underwent radical treatment, at a median follow-up of 6.8 years, some doubts remain for long-term outcomes in men reclassified as progressed who were referred to delayed treatment as noted by the authors. An uncertainty immediately arises, considering the median patient age was 70.3 years, and ongoing studies on prostate cancer, such as the European Prostate Cancer Research International: Active Surveillance (PRIAS) project, offer active surveillance that include all patients. The Canadian study reported that patients received an initial biopsy according to the Vienna nomogram scheme of eight to 14 core biopsies, depending on patient age and gland volume. However, the study began in November 1995 and the Vienna nomogram was published in 2005. Before 1998, no studies reported an extended prostate biopsy scheme, which is at least eight cores (sextant plus two lateral biopsies). Thus, it is likely that the cohort was not homogeneous in its accuracy of cancer risk definition among patients recruited at the beginning of the study and afterward. We think a more accurate initial biopsy schedule (the Vienna nomogram should be optimal) may enhance detection accuracy of patients at higher cancer risk in terms of the number of positive cores and reliability of the Gleason score, and, most importantly, identify the true low-risk patients suitable for surveillance.