Characteristics of Cancer Progression on Serial Biopsy in Men on Active Surveillance for Early-stage Prostate Cancer: Implications for Focal Therapy
Characteristics of Cancer Progression on Serial Biopsy in Men on Active Surveillance for Early-stage Prostate Cancer: Implications for Focal Therapy
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DOI：
10.1016/j.euo.2020.08.002
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发表时间：
2022-02-26
影响因子：
8.2
通讯作者：
Carroll, Peter R.
中科院分区：
文献类型：
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作者：
Fasulo, Vittorio;Cowan, Janet E.;Carroll, Peter R.
背景：主动监测（AS）是管理低风险前列腺癌男性的安全和可接受的选择。然而，一些患者对AS缺乏信心或无法获得AS。局部治疗（FT）是一种可能的替代根治性治疗这类患者。目的：我们通过一系列活检评估显性肿瘤（DT）的进展，以确定AS患者是否可以作为FT的合理候选人。设计、设置和参与者：纳入了1996年至2017年期间在加州大学旧金山分校弗朗西斯科就读AS的低/中等风险男性。结果测量和统计分析：评估了DT的活检分级、体积和病灶随时间的变化。病灶性（FT的好或差）由核心数量、偏侧性和包含肿瘤的前列腺部位的连续性（基于病理学报告）定义。候选者（靶向/象限消融或半黑质消融）是根据良好的局灶性、级别组（GG）< 2和低体积疾病定义的。在监测活检时，患者被分类为有利（GG < 2，具有良好的局灶性和一致的多参数磁共振成像[mpMRI]）或不利（局灶性差或高体积疾病或不一致的mpMRI）。结果和局限性：共有1057名男性符合纳入标准。每例患者活检的中位数为3次（四分位数范围2-4），196例患者（18.5%）接受了5次或更多次活检。在确认性活检时，43%仍为FT的候选者（靶向/象限消融为67%，半胰岛消融为33%），20%的活检结果为阴性。在首次活检时进行FT的候选者中，11%在确认活检时具有不太有利的特征。在基于初始和确认活检的FT候选者中，70%的患者在后续活检中仍然有利于半胰岛消融。局限性包括回顾性设计和仅在监测活检时提供mpMRI信息。结论：AS早期癌症男性患者的系列活检结果显示，肿瘤位置保持相对稳定，并且在DT中主要发生级别和/或体积的显著变化。结合诊断性和确证性活检结果有助于更好地选择FT患者，而不是单独使用诊断性活检。患者总结：在一个大的前列腺癌患者积极监测队列中，我们评估了连续活检的变化，以确定病灶治疗（FT）的潜在候选者。我们的研究结果表明，随着时间的推移，主要肿瘤保持稳定，大多数男性是FT的有利候选人。(c)2020年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Active surveillance (AS) is a safe and accepted option for managing men with low-risk prostate cancer. Nevertheless, some patients lack confidence in or access to AS. Focal therapy (FT) is a possible alternative to radical treatment for such patients. Objective: We evaluated dominant tumor (DT) progression across serial biopsies to determine whether men on AS could be reasonable candidates for FT. Design, setting, and participants: Men enrolled in AS at University of California, San Francisco between 1996 and 2017 with low/intermediate risk were included. Outcome measurements and statistical analysis: Changes in biopsy grade, volume, and focality of the DT over time were assessed. Focality (good or poor for FT) was defined by the number of cores, laterality, and contiguity of prostate sites containing tumor (based on pathology reports). Candidates (either for targeted/quadrant ablation or for hemigland ablation) were defined based on good focality, grade group (GG) < 2, and low-volume disease. Patients were classified as favorable (GG < 2 with good focality and concordant multiparametric magnetic resonance imaging [mpMRI]) or unfavorable (poor focality or high-volume disease or discordant mpMRI) for FT at surveillance biopsies. Results and limitations: A total of 1057 men met the inclusion criteria. The median number of biopsies per patient was three (interquartile range 2-4), and 196 patients (18.5%) underwent five or more biopsies. At confirmatory biopsy, 43% remained candidates for FT (67% for targeted/quadrant ablation and 33% for hemigland ablation) and 20% had a negative biopsy. Of the candidates for FT at initial biopsy, 11% had less favorable characteristics at confirmatory biopsy. Among candidates for FT based on both initial and confirmatory biopsies, 70% remained favorable for hemigland ablation at subsequent biopsies. Limitations include retrospective design and mpMRI information only at surveillance biopsy. Conclusions: Serial biopsy findings in men with early-stage cancer on AS show that tumor location remains relatively stable and significant changes in grade and/or volume occur largely in the DT. Combined diagnostic and confirmatory biopsy findings help better select patients for FT than the use of the diagnostic biopsy alone. Patient summary: In a large cohort of patients on active surveillance for prostate cancer, we evaluated changes across serial biopsies to identify potential candidates for focal therapy (FT). Our findings showed that the dominant tumor remained stable over time and the majority of men were favorable candidates for FT.(c) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.