Meaningful end points and outcomes in men on active surveillance for early-stage prostate cancer.
Meaningful end points and outcomes in men on active surveillance for early-stage prostate cancer.
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DOI：
10.1097/mou.0000000000000039
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发表时间：
2014-05
影响因子：
2.5
通讯作者：
Carroll PR
中科院分区：
文献类型：
--
作者：
Welty CJ;Cooperberg MR;Carroll PR
主动监测是早期前列腺癌的一种管理策略，旨在平衡侵袭性疾病的早期发现和惰性疾病的过度治疗。我们评估最近报道的结果，并讨论这种方法的潜在最重要的终点。在过去的两年里，发表了两项关于警惕等待与立即治疗的试验，并更新了对早期前列腺癌男性的多个积极监测队列。密切观察的等待试验显示，当应用于所有风险水平(15年绝对差异6%)时，立即治疗的潜在死亡率好处很小，强调了风险适应策略的重要性。在报道的积极监测队列中，前列腺癌死亡和转移仍然是罕见的事件。中间结果，如进展到治疗和最终病理上的升级/升级，在队列中似乎是一致的，但与由于潜在的选择偏差而立即治疗的历史对照相比，必须谨慎地解释。最近的报告加强了主动监测的安全性。积累更多关于患有中等风险癌症的男性的数据，开发和验证新的风险生物标记物，将使这一方法得到改进，并有可能扩大使用。
Active surveillance is a management strategy for early stage prostate cancer designed to balance early detection of aggressive disease and overtreatment of indolent disease. We evaluate recently reported outcomes and discuss the potentially most important endpoints for such an approach. The past two years have seen the publication of two trials of watchful waiting versus immediate treatment and updates of multiple active surveillance cohorts for men with early stage prostate cancer. The watchful waiting trials demonstrated a small potential mortality benefit to immediate treatment when applied to all risk levels (6% absolute difference at 15 years), emphasizing the importance of a risk adapted strategy. In reported active surveillance cohorts, prostate cancer death and metastasis remain rare events. Intermediate outcomes such as progression to treatment and upgrading/upstaging on final pathology appear consistent among cohorts but must be interpreted with caution when compared to historical controls of immediate treatment due to potential selection bias. The safety of active surveillance has been reinforced by recent reports. Accumulation of additional data on men with intermediate risk cancer and development and validation of new biomarkers of risk will allow refined and, likely, expanded use of this approach.