The changing face of low-risk prostate cancer: Trends in clinical presentation and primary management
The changing face of low-risk prostate cancer: Trends in clinical presentation and primary management
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DOI：
10.1200/jco.2004.10.062
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发表时间：
2004-06-01
影响因子：
45.3
通讯作者：
Carroll, PR
中科院分区：
文献类型：
--
作者：
Cooperberg, MR;Lubeck, DP;Carroll, PR
目的。前列腺癌的早期干预与良好的长期生存率相关，但许多受影响的男性，特别是那些具有低风险疾病特征的男性，如果推迟治疗，可能不会对生存或生活质量产生不利影响。我们试图描述低风险前列腺癌患者的临床表现和原发疾病管理的时间趋势。数据摘自前列腺癌战略泌尿学研究项目（CaPSURE），该项目登记了8,685名不同阶段前列腺癌的男性。纳入了1989年至2001年间诊断的2078名男性，血清前列腺特异性抗原小于或等于10 ng/mL， Gleason总和小于或等于6，临床T期小于或等于2a。评估了风险分布、肿瘤特征和初步治疗的趋势。具有低危肿瘤特征的患者比例从1989 - 1992年的29.8%上升到1999 - 2001年的45.3% （P < 0.0001）。近距离放疗和雄激素剥夺单一疗法的使用急剧增加，分别从3.1%和3.1%增加到12.0%和21.7%。前列腺切除术、外束放疗和观察的使用率也相应下降，从63.8%、16.1%和13.8%下降到51.6%、6.8%和7.9%（除前列腺切除术外，P < 0.0001）。年龄和社会经济地位与治疗选择显著相关，但总体而言，75岁及以上患者的治疗趋势与亚组分析相呼应。越来越多的前列腺癌患者具有低风险特征，低风险疾病的治疗也发生了重大变化。过度治疗可能是一个日益严重的问题，尤其是在老年患者中。(C) 2004年由美国临床肿瘤学会出版。
Purpose. Early intervention for prostate cancer is associated with excellent long-term survival, but many affected men, especially those with low-risk disease characteristics, might not experience adverse impact to survival or quality of life were treatment deferred. We sought to characterize temporal trends in clinical presentation and primary disease management among patients with low-risk prostate cancer.Methods. Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a disease registry of 8,685 men with various stages of prostate cancer. Included were 2,078 men who were diagnosed between 1989 and 2001 and had a serum prostate specific antigen less than or equal to 10 ng/mL, Gleason sum less than or equal to 6, and clinical T stage less than or equal to 2a. Trends in risk distribution, tumor characteristics, and primary treatment were evaluated.Results. The proportion of patients with low-risk tumor characteristics rose from 29.8% in 1989 to 1992, to 45.3% in 1999 to 2001 (P < .0001). There have been sharp increases in the use of brachytherapy and androgen deprivation monotherapy, from 3.1 % and 3.1 %, to 12.0% and 21.7%, respectively. Utilization rates for prostatectomy, external-beam radiotherapy, and observation have fallen accordingly, from 63.8%, 16.1%, and 13.8%, to 51.6%, 6.8%, and 7.9% P < .0001 for all except prostatectomy (P = .00191). Age and socioeconomic status were significantly associated with treatment selection, but overall, the treatment trends were echoed on subgroup analysis of patients 75 years or older.Conclusion. Low-risk features characterize a growing proportion of prostate cancer patients, and there have been significant shifts in the management of low-risk disease. Overtreatment may be a growing problem, especially among older patients. (C) 2004 by American Society of Clinical Oncology.