Klotz Laurence
Department of Surgery, University of Toronto, Ontario, Canada.
J Urol. 2004 Nov;172(5 Pt 2):S48-50; discussion S50-1. doi: 10.1097/01.ju.0000141712.79986.77.
This article reviews the data supporting an approach of active surveillance with selective delayed intervention for good risk localized prostate cancer. 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.
A prospective phase 2 study of active surveillance with selective delayed intervention was initiated in 1995. Patients were treated initially with surveillance, while those who had a prostate specific antigen (PSA) doubling time (DT) of 2 years or less, or grade progression on re-biopsy were offered radical intervention. The remainder were closely monitored.
The cohort consisted of 299 patients with good risk prostate cancer or intermediate risk prostate cancer in men older than 70 years. Median PSA DT was 7.0 years and 35% of the men had a PSA DT of greater than 10 years. The majority of patients remain on surveillance. At 8 years overall actuarial survival was 85% and disease specific survival was 99%.
Most men with favorable risk prostate cancer will die of unrelated causes. The approach of active surveillance with selective delayed intervention based on PSA DT represents a practical compromise between radical therapy in all, which results in overtreatment in patients with indolent disease, and watchful waiting with palliative therapy only, which results in under treatment in those with aggressive disease. Results at 8 years are favorable. Longer followup will be required to confirm the safety of this approach in men with long (greater than 15-year) life expectancy.
本文回顾了支持对低风险局限性前列腺癌采用主动监测与选择性延迟干预方法的数据。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。
1995年启动了一项关于主动监测与选择性延迟干预的前瞻性2期研究。患者最初接受监测，而那些前列腺特异性抗原（PSA）倍增时间（DT）为2年或更短，或再次活检时分级进展的患者则接受根治性干预。其余患者进行密切监测。
该队列包括299例低风险前列腺癌或70岁以上男性的中风险前列腺癌患者。PSA DT的中位数为7.0年，35%的男性PSA DT大于10年。大多数患者仍在接受监测。8年时的总精算生存率为85%，疾病特异性生存率为99%。
大多数低风险前列腺癌男性将死于非相关原因。基于PSA DT的主动监测与选择性延迟干预方法是一种实际的折衷方案，介于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）和仅进行观察等待及姑息治疗（这会导致侵袭性疾病患者治疗不足）之间。8年的结果是良好的。需要更长时间的随访来证实这种方法对预期寿命长（大于15年）的男性的安全性。
