A Multi-institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer
A Multi-institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer
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DOI：
10.1016/j.juro.2008.11.109
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发表时间：
2009-04-01
影响因子：
6.6
通讯作者：
Guillonneau, Bertrand
中科院分区：
文献类型：
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作者：
Eggener, Scott E.;Mueller, Alex;Guillonneau, Bertrand
目的：对于低风险前列腺癌患者，主动监测通常被认为是一种管理策略。在一项多中心回顾性研究中，我们评估了延迟根治性前列腺切除术的精算率和持续积极监测的预测因素、癌症进展的发生率和病理结果。材料和方法：来自4个机构的262名男性符合入选标准：年龄75岁及以下，前列腺特异性抗原10 ng/ml及以下，临床分期T1-T2a，活检Gleason sum≤6，诊断活检阳性核心≤3，重复活检前主动监测，重复活检后6个月未治疗。主动监测从第二次活检开始。计算继续进行主动监测的精算率，并使用单变量Cox回归评估停止主动监测的预测因子。结果：中位随访29个月，43例患者最终接受了积极治疗。2年和5年继续进行主动监测的概率分别为91%和75%。在第二次活检中发现癌症的患者（HR 2.23, 95% CI 1.23-4.06, p = 0.007）和在两次活检中发现更多癌核的患者（p = 0.002）更有可能接受治疗。年龄、前列腺特异性抗原、临床分期、前列腺体积和取样的总活检芯数不能预测结果。1例患者在开始主动监测38个月后出现骨骼转移。在接受延迟治疗的43例患者中，41例（95%）在治疗后的中位23个月没有疾病进展。结论：在中位随访29个月的情况下，对选定的患者进行主动监测似乎是安全的，并且与系统性进展的低风险相关。重新活检时的癌症和较高的癌核总数与继续进行主动监测的可能性较低相关。应强烈考虑重新活检，以确定是否有资格进行主动监测。
Purpose: For select men with low risk prostate cancer active surveillance is more often being considered a management strategy. In a multicenter retrospective study we evaluated the actuarial rates and predictors of remaining on active surveillance, the incidence of cancer progression and the pathological findings of delayed radical prostatectomy.Materials and Methods: A cohort of 262 men from 4 institutions met the inclusion criteria of age 75 years or younger, prostate specific antigen 10 ng/ml or less, clinical stage T1-T2a, biopsy Gleason sum 6 or less, 3 or less positive cores at diagnostic biopsy, repeat biopsy before active surveillance and no treatment for 6 months following the repeat biopsy. Active surveillance started on the date of the second biopsy. Actuarial rates of remaining on active surveillance were calculated and univariate Cox regression was used to assess predictors of discontinuing active surveillance.Results: With a median followup of 29 months 43 patients ultimately received active treatment. The 2 and 5-year probabilities of remaining on active surveillance were 91% and 75%, respectively. Patients with cancer on the second biopsy (HR 2.23, 95% CI 1.23-4.06, p = 0.007) and a higher number of cancerous cores from the 2 biopsies combined (p = 0.002) were more likely to undergo treatment. Age, prostate specific antigen, clinical stage, prostate volume and number of total biopsy cores sampled were not predictive of outcome. Skeletal metastases developed in 1 patient 38 months after starting active surveillance. Of the 43 patients undergoing delayed treatment 41 (95%) are without disease progression at a median of 23 months following treatment.Conclusions: With a median followup of 29 months active surveillance for select patients appears to be safe and associated with a low risk of systemic progression. Cancer at restaging biopsy and a higher total number of cancerous cores are associated with a lower likelihood of remaining on active surveillance. A restaging biopsy should be strongly considered to finalize eligibility for active surveillance.