Active Surveillance for Low-Risk Prostate Cancer
Active Surveillance for Low-Risk Prostate Cancer
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DOI：
10.1007/s11934-015-0492-z
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发表时间：
2015-04-01
影响因子：
2.6
通讯作者：
Klotz, Laurence
中科院分区：
文献类型：
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作者：
Klotz, Laurence
有充分的证据表明，低风险和许多低/中风险前列腺癌病例是惰性的，几乎没有或没有转移潜力，并且在患者的一生中不会对患者构成威胁。在了解这些患者是谁和鼓励对这些患者使用保守治疗方面取得了重大进展。保守治疗的一个组成部分是早期识别那些患有高风险疾病的“低风险”患者，并从明确的治疗中获益。这代表了约30%的新诊断的低风险患者。还有一小部分低风险疾病患者表现出生物学进展为更高级别的疾病。患有较低风险疾病的男性可以推迟治疗，在大多数情况下是终生的。患有可以局限于相对较小体积的前列腺的高风险疾病的男性可以接受选择性治疗。主动监测的结果，体现了保守管理与选择性延迟干预的子集谁被重新分类为高风险的基础上，重复活检，成像或生物标志物结果超时已显示，这种方法是安全的中期至长期，与3%的癌症特异性死亡率在10-15年。目前正在进一步完善监测方法，包括MRI、靶向活检和分子生物标志物。
There is ample evidence that low risk and many cases of low-/intermediate-risk prostate cancer, are indolent, have little or no metastatic potential, and do not pose a threat to the patient in his lifetime. Major strides have been made in understanding who these patients are and in encouraging the use of conservative management in such individuals. A component of conservative management is the early identification of those `low-risk' patients who harbour higher risk disease, and benefit from definitive therapy. This represents about 30 % of newly diagnosed low-risk patients. A further small proportion of patients with low-risk disease demonstrate biological progression to higher grade disease. Men with lower risk disease can defer treatment, in most cases for life. Men with higher risk disease that can be localized to a relatively small volume of the prostate can undergo selective therapy. The results of active surveillance, embodying conservative management with selective delayed intervention for the subset who are re-classified as higher risk overtime based on repeat biopsy, imaging or biomarker results have shown that this approach is safe in the intermediate to long term, with a 3 % cancer specific mortality at 10-15 years. Further refinement of the surveillance approach is ongoing, incorporating MRI, targeted biopsies and molecular biomarkers.