The changing face of prostate cancer
The changing face of prostate cancer
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DOI：
10.1200/jco.2005.02.9751
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发表时间：
2005-11-10
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;Moul, JW;Carroll, PR
前列腺癌仍然是人类最常见的非皮肤恶性肿瘤，也是男性中第二大致死性肿瘤。然而，该疾病的自然史通常是延长的，并且低风险肿瘤男性的局部治疗的生存益处可能在十年或更长时间内无法实现，正如在美国和欧洲的长期观察队列中越来越好地证明的那样。很大一部分患有前列腺癌的男性可能被过度诊断，从某种意义上说，诊断可能不会改善他们的寿命或生活质量。然而，过度诊断在多大程度上代表了一个真正的问题，这与诊断总是导致积极治疗的一致性有关。前列腺癌的诊断阶段越来越早，风险特征也越来越低--尽管有这些趋势，但与十年前相比，现在患者接受主动监测试验的可能性更小。特别是近距离放射治疗和激素治疗的使用率显著上升。近年来，前列腺癌风险评估取得了重要进展。这些进展，结合后期发展阶段的生物标志物，预计在未来几年内将进一步提高临床医生早期诊断前列腺癌的能力，并指导适当选择的患者接受越来越多的定制治疗。
Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumor among men. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumors may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both the United States and Europe. A significant proportion of men with prostate cancer may be overdiagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which overdiagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Prostate cancer is diagnosed at progressively earlier stages and with lower risk features-, despite these trends, patients are less likely now than a decade ago to undergo a trial of active surveillance. Rates of brachytherapy and hormonal therapy use, in particular, have risen markedly. Important progress has been made in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the coming years to yield further improvements in clinicians' ability to diagnose prostate cancer early, and guide appropriately selected patients toward increasingly tailored treatment.