Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer.
Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer.
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DOI：
10.1016/j.juro.2010.09.095
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发表时间：
2011-02
期刊：
影响因子：
--
通讯作者：
Eastham JA
中科院分区：
文献类型：
--
作者：
Adamy A;Yee DS;Matsushita K;Maschino A;Cronin A;Vickers A;Guillonneau B;Scardino PT;Eastham JA
我们评估了开始主动监测后进展的预测因素，特别是前列腺特异性抗原和立即确诊性前列腺活检的作用。共有238名前列腺癌患者符合主动监测的资格标准，并随时间分析其进展情况。采用Cox比例风险回归评价进展的预测因子。评估进展使用2种定义，包括不再满足1)完全标准和2)修改标准，排除前列腺特异性抗原大于10 ng/ml作为标准。使用完整标准，61例患者在随访期间进展。2年和5年无进展概率分别为80%和60%。当前列腺特异性抗原纳入进展标准时，确诊活检时前列腺特异性抗原（HR 1.29, 95% CI 1.14-1.46, p <0.0005）和确诊活检阳性（HR 1.75, 95% CI 1.01-3.04, p = 0.047）是进展的独立预测因子。在61例病例中，34例因前列腺特异性抗原升高而失败，其中只有5例根据活检标准出现后续进展。当排除前列腺特异性抗原作为进展标准时，只有32例进展，2年和5年无进展概率分别为91%和76%。使用修改后的标准作为终点，确认性活检阳性是唯一独立的进展预测因子（HR 3.16, 95% CI 1.41-7.09, p = 0.005）。主动监测在低风险前列腺癌患者中是可行的，大多数患者在5年内几乎没有进展的迹象。在没有其他肿瘤进展迹象的情况下，没有明确的理由治疗前列腺特异性抗原升高超过10 ng/ml的患者。考虑主动监测的患者应接受确诊活检，以更好地评估进展风险。
We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy. A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion. Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.14–1.46, p <0.0005) and positive confir-matory biopsy (HR 1.75, 95% CI 1.01–3.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.41–7.09, p = 0.005). Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirma-tory biopsy to better assess the risk of progression.
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