Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers
Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers
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DOI：
10.1007/s00345-015-1603-7
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发表时间：
2015-07-01
影响因子：
3.4
通讯作者：
Stief, Christian G.
中科院分区：
文献类型：
--
作者：
van der Poel, Henk;Klotz, Laurence;Stief, Christian G.
在接受PSA筛查的新诊断男性中，约有一半发现了低风险前列腺癌。为了明确主动监测和局灶治疗在低危和中危前列腺癌中的作用，一个由局限性前列腺癌领域执业医师组成的国际小组在连续三次会议上讨论了现有文献，对现有数据进行了广泛的解释。该小组（“新前列腺癌管理小组”，npm）同意以下观察结果。对于大多数患有小体积Gleason 6肿瘤的男性，最初的保守治疗是合适的。对于Gleason评分为6或3 + 4的单灶性病变较大的男性，局灶治疗虽然仍被认为是一种研究性方法，但在早期的非随机比较研究中似乎是一种合适的选择。此外，对于存在较大指向性病变的多灶小卫星Gleason 6病变患者，可选择对指向性病变进行局灶治疗。对于高级别、大体积前列腺癌患者，或有证据表明有大体积多灶性低级别前列腺癌的年轻男性，应考虑全腺体治疗。主动监测是低风险前列腺癌的首选和安全选择。局灶性治疗仍在研究中，但现有的II期数据是有希望的。临床益处必须在前瞻性试验中显示。随着影像学的改善，对于不选择主动监测的低风险疾病、主动监测后有进展或病变可定位的中等风险癌症的患者，局灶治疗可能是一种选择。
Low-risk prostate cancer is found in about half of newly diagnosed men subjected to PSA screening.To define the role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers, an invited international panel of practicing physicians in the field of localized prostate cancer discussed the available literature in three consecutive meetings to come to a broad interpretation of the available data.The panel ("new prostate cancer management group," npm) agreed on the following observations. In most men with a low-volume Gleason 6 tumor, initial conservative management is appropriate. In men with a larger unifocal Gleason score 6 or 3 + 4 lesion, focal therapy, although still considered an investigational approach, appears to be a suitable option in early non-randomized comparison studies. Furthermore, in patients with multifocal small satellite Gleason 6 lesions in the presence of a larger index lesion, focal therapy of the index lesion is an option. For patients with high-grade, large-volume disease, or in young men with evidence of high-volume multifocal low-grade prostate cancer, whole-gland treatment should be considered.Active surveillance is a preferred and safe option for low-risk prostate cancer. Focal therapy is still under investigation, but the available phase II data are promising. Clinical benefits must be shown in prospective trials. With improved imaging, focal therapy may be an option for patients not choosing active surveillance with low-risk disease, progression upon active surveillance or intermediate-risk cancers with a localizable lesion.