Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study.
Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study.
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DOI：
10.21037/tau.2017.12.28
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发表时间：
2018-03
影响因子：
2
通讯作者：
PRIAS study group
中科院分区：
文献类型：
--
作者：
Drost FH;Rannikko A;Valdagni R;Pickles T;Kakehi Y;Remmers S;van der Poel HG;Bangma CH;Roobol MJ;PRIAS study group
低风险前列腺癌（PCa）的主动监测（AS）似乎提供了极好的长期PCa特异性和总生存率。选择AS作为初始治疗主要是基于避免侵入性治疗的副作用;但AS需要定期检查，并且仍然有可能转换或决定转换为侵入性治疗。在此，我们评估了真实的临床实践中AS的长期随访数据。对来自8个国家的30个中心在2008年7月之前入组PRIAS的前500名男性的数据进行分析，以提供长期随访结果。建议男性定期进行前列腺特异性抗原（PSA）检测、直肠指检和前列腺活检。如果男性患者的疾病重新分类[活检Gleason评分（GS）≥3+4，两个以上阳性活检芯，高于cT 2的分期]或PSA加倍时间为0-3年，则建议他们转为侵入性治疗。我们评估了AS的时间、结果和停止AS的原因，以及潜在的不必要活检和治疗的发生率。中位随访时间为6.5年。在此期间，325名（65%）男性在中位数2.3年后停药，121名（24%）男性在中位数7.3年后没有最近（>1年）的数据更新。其余54名（11%）男性被证实仍在服用AS。大多数男性根据方案建议停药; 38%有其他原因。在随访期间，进行了838次活检，其中79%至90%没有导致重新分类，这取决于标准。在325例停药的男性中，112例随后接受了根治性乳房切除术（RP），126例接受了放疗，57例转为观察等待（WW）或死亡，30例接受了其他或未知的治疗。99名男性的RP结果可用：34%至68%（取决于定义）具有有利结局; 50%的不利结局发生在前2年。在30例（6%）死亡男性中，1例男性死于PCa。这些数据反映了真实的临床实践，表明超过一半的男性在2.3年内转为侵入性治疗，表明AS能够减少过度诊断的不良影响的程度有限。因此，尽管指南指出PCa诊断必须与治疗脱钩，但尽可能避免过度诊断PCa仍然很重要。
Active surveillance (AS) for low-risk prostate cancer (PCa) appears to provide excellent long-term PCa-specific and overall survival. The choice for AS as initial treatment is mainly based on avoiding side effects from invasive treatment; but AS entails regular check-ups and the possibility of still having to switch or deciding to switch to invasive treatment. Here, we assessed the long-term follow-up data from AS in real life clinical practices. Data from the first 500 men, enrolled in PRIAS before July 2008 by 30 centers across 8 countries, were analyzed to provide long-term follow-up results. Men were advised to be regularly examined with prostate-specific antigen (PSA) tests, digital rectal examinations, and prostate biopsies. Men were advised to switch to invasive treatment if they had disease reclassification [Gleason score (GS) ≥3+4 on biopsy, more than two positive biopsy cores, a stage higher than cT2] or a PSA-doubling time of 0–3 years. We assessed time on AS, outcomes and reasons for discontinuing AS, and rates of potential unnecessary biopsies and treatments. The median follow-up time was 6.5 years. During this period, 325 (65%) men discontinued after a median of 2.3 years and 121 (24%) men had no recent (>1 year) data-update after a median of 7.3 years. The remaining 54 (11%) men were confirmed to be still on AS. Most men discontinued based on protocol advice; 38% had other reasons. During follow-up, 838 biopsy sessions were performed of which 79% to 90% did not lead to reclassification, depending on the criteria. Of the 325 discontinued men, 112 subsequently underwent radical prostatectomy (RP), 126 underwent radiotherapy, 57 switched to watchful waiting (WW) or died, and 30 had another or unknown treatment. RP results were available of 99 men: 34% to 68%, depending on definition, had favorable outcomes; 50% of unfavorable the outcomes occurred in the first 2 years. Of the 30 (6%) men who died, 1 man died due to PCa. These data, reflecting real life clinical practice, show that more than half of men switched to invasive treatment within 2.3 years, indicating limitations to the extent in which AS is able to reduce the adverse effects of overdiagnosis. Therefore, despite guidelines stating that PCa diagnosis must be uncoupled from treatment, it remains important to avoid overdiagnosing PCa as much as possible.
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影响因子：
5
作者：
Barrett, Tristan;Haider, Masoom A.
通讯作者：
Haider, Masoom A.
DOI：
10.1097/pas.0b013e3182556dcd
发表时间：
2012-09
期刊：
The American journal of surgical pathology
影响因子：
--
作者：
Ross HM;Kryvenko ON;Cowan JE;Simko JP;Wheeler TM;Epstein JI
通讯作者：
Epstein JI
影响因子：
23.4
作者：
Loeb, Stacy;Bjurlin, Marc A.;Nicholson, Joseph;Tammela, Teuvo L.;Penson, David F.;Carter, H. Ballentine;Carroll, Peter;Etzioni, Ruth
通讯作者：
Etzioni, Ruth
影响因子：
28.4
作者：
Loeb S;Folkvaljon Y;Curnyn C;Robinson D;Bratt O;Stattin P
通讯作者：
Stattin P
影响因子：
6.6
作者：
Jain, Suneil;Loblaw, Andrew;Klotz, Laurence
通讯作者：
Klotz, Laurence