Klotz Laurence
Division of Urology, Sunnybrook & Women's College, Health Sciences Centre, Toronto, ON, Canada.
Clin Prostate Cancer. 2003 Sep;2(2):106-10. doi: 10.3816/cgc.2003.n.017.
Prostate cancer is an indolent, slow-growing disease in many patients and may not pose a threat during a patient's lifetime. The challenge is to identify those patients who are not likely to experience significant progression while offering radical therapy to those who are at risk. To date, molecular markers have failed to provide sufficiently reliable predictive information to influence decision-making. The approach to favorable-risk prostate cancer described in this article uses estimation of prostate-specific antigen doubling time (PSA DT) to stratify patients according to the risk of progression. Patients who select this approach initially undergo management with active surveillance; those who have a PSA DT <or=3 years (based on a minimum of 3 determinations over a period of 6 months) are offered radical intervention. The remainder are closely monitored. In a series of 231 patients in a study by our group, the median doubling time was 7.0 years; 42% had a PSA DT > 10 years and 20% had a PSA DT > 100 years. The majority of patients in this study continue to undergo surveillance. The approach of active surveillance with selective delayed intervention based on PSA DT represents a practical compromise between radical therapy for all (which results in overtreatment of patients with indolent disease) and watchful waiting with palliative therapy only (which results in undertreatment of patients with aggressive disease).
在许多患者中，前列腺癌是一种发展缓慢、惰性的疾病，在患者的一生中可能不会构成威胁。挑战在于识别那些不太可能出现显著进展的患者，同时为有风险的患者提供根治性治疗。迄今为止，分子标志物未能提供足够可靠的预测信息来影响决策。本文所述的低危前列腺癌治疗方法是利用前列腺特异性抗原倍增时间（PSA DT）的估计值，根据疾病进展风险对患者进行分层。选择这种方法的患者最初接受主动监测；PSA DT≤3年（基于6个月内至少3次测定）的患者接受根治性干预。其余患者则密切监测。在我们团队的一项研究中的231例患者系列中，中位倍增时间为7.0年；42%的患者PSA DT>10年，20%的患者PSA DT>100年。该研究中的大多数患者继续接受监测。基于PSA DT进行主动监测并选择性延迟干预的方法，是对所有患者进行根治性治疗（这会导致惰性疾病患者过度治疗）和仅进行姑息治疗的观察等待（这会导致侵袭性疾病患者治疗不足）之间的一种实际折衷。
