Meng Maxwell V, Elkin Eric P, Harlan Susan R, Mehta Shilpa S, Lubeck Deborah P, Carroll Peter R
Department of Urology, University of California-San Francisco/Mt. Zion Cancer Center, 94143-0738, USA.
J Urol. 2003 Dec;170(6 Pt 1):2279-83. doi: 10.1097/01.ju.0000094190.46523.b2.
Expectant management of prostate cancer or watchful waiting (WW) is a reasonable option for some men with clinically localized prostate cancer. We identified predictors of eventual prostate cancer treatment in a cohort of men initially choosing WW.
We identified 457 men in the Cancer of the Prostate Strategic Urologic Research Endeavor data base selecting WW as initial management without subsequent treatment for at least 6 months. A subset of these men eventually received active treatment for prostate cancer. These groups were compared with respect to baseline clinical, sociodemographic characteristics and followup prostate specific antigen (PSA) characteristics using Kaplan-Meier life tables and Cox proportional hazards models to determine predictors of active treatment after WW.
Of the 457 men initially on WW 188 (41%) went on to active treatment at a median of 1.7 years after diagnosis. Baseline characteristics associated with progression to active treatment included younger age, higher level of formal education, higher PSA and higher Gleason grade. Actuarial freedom from treatment (that is continued WW) was 74% at 2, 63% at 3 and 49% at 5 years with androgen deprivation the most common form of therapy (72%). Men progressing to treatment had higher baseline and followup PSA as well as a significantly greater PSA change that those remaining on WW (7.2 vs -0.4 ng/ml). Other measures of PSA dynamics also predicted eventual active treatment. These observations persisted in multivariate models.
WW is an appropriate and common form of treatment in many men with prostate cancer and about half remain on WW at 5 years. Our analysis of national practice patterns identified demographic, clinical and PSA characteristics associated with men who continue with this modality. Conversely these factors may help determine which men (for example higher risk/PSA) ultimately receive active treatment despite initial treatment preference and allow investigation of the effects of these interventions on cancer outcomes and quality of life.
对于一些临床局限性前列腺癌患者，前列腺癌的期待性管理或观察等待（WW）是一种合理的选择。我们在一组最初选择WW的男性队列中确定了最终接受前列腺癌治疗的预测因素。
我们在前列腺癌战略泌尿学研究努力数据库中识别出457名男性，他们选择WW作为初始管理方式，且至少6个月未接受后续治疗。这些男性中的一部分最终接受了前列腺癌的积极治疗。使用Kaplan-Meier生存表和Cox比例风险模型，对这些组在基线临床、社会人口统计学特征以及随访前列腺特异性抗原（PSA）特征方面进行比较，以确定WW后积极治疗的预测因素。
在最初接受WW的457名男性中，188名（41%）在诊断后中位1.7年时继续接受积极治疗。与进展至积极治疗相关的基线特征包括年龄较轻、受教育程度较高、PSA水平较高以及Gleason分级较高。2年时无需治疗（即持续WW）的精算概率为74%，3年时为63%，5年时为49%，雄激素剥夺是最常见的治疗形式（72%）。进展至治疗的男性基线和随访PSA水平较高，且PSA变化显著大于继续接受WW的男性（7.2 vs -0.4 ng/ml）。PSA动态变化的其他指标也可预测最终的积极治疗。这些观察结果在多变量模型中持续存在。
WW是许多前列腺癌男性合适且常见的治疗形式，约一半患者在5年时仍继续接受WW。我们对全国实践模式的分析确定了与继续采用这种治疗方式的男性相关的人口统计学（译者注：此处原文demographic应为demographic，可能是拼写错误）、临床和PSA特征。相反，这些因素可能有助于确定哪些男性（例如高风险/PSA患者）尽管最初有治疗偏好但最终仍接受积极治疗，并有助于研究这些干预措施对癌症结局和生活质量的影响。
