Roemeling Stijn, Roobol Monique J, Postma Renske, Gosselaar Claartje, van der Kwast Theo H, Bangma Chris H, Schröder Fritz H
Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Eur Urol. 2006 Sep;50(3):475-82. doi: 10.1016/j.eururo.2006.04.019. Epub 2006 May 3.
Screening practices for prostate cancer have resulted in an increasing incidence of prostate cancers. Our knowledge about which prostate cancers are life threatening and which are not is limited. Thus, for ethical, medical, and economic reasons we need to define which patients can be managed by active surveillance.
From 1993 through 1999, men from the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC) were screened by two strict protocols, which were based on prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound. For this study, men with criteria that reflect current active surveillance studies were selected: those with a biopsy Gleason score < or =3+3 in two or fewer cores, with a PSA density <0.2 and a maximum PSA-level of 15 ng/ml. Clinical stage had to be T1C or T2.
Of the 1,014 prostate cancers detected in the prevalence screen, 293 men (28.9%) met the criteria for active surveillance. Their mean age was 65.7 and the mean PSA level was 4.8 ng/ml. Radical prostatectomy was elected by 136 men (46.4%), radiotherapy by 91 (31.1%), and watchful waiting by 64 (21.8%). The mean follow-up was 80.8 months. The eight-year prostate cancer-specific survival was 99.2%; the overall survival was 85.4%. Nineteen men who chose watchful waiting changed to definitive treatment during follow-up.
Only three men died of prostate cancer, none of whom were on watchful waiting. Our observations provide preliminary validation of the arbitrary selection criteria for active surveillance.
前列腺癌的筛查方法导致前列腺癌发病率不断上升。我们对于哪些前列腺癌会危及生命、哪些不会的了解有限。因此，出于伦理、医学和经济方面的原因，我们需要确定哪些患者可以通过积极监测来管理。
1993年至1999年期间，来自欧洲前列腺癌筛查随机研究（ERSPC）鹿特丹分部的男性接受了两项严格方案的筛查，这些方案基于前列腺特异性抗原（PSA）、直肠指检和经直肠超声检查。在本研究中，选择了符合当前积极监测研究标准的男性：那些在两个或更少穿刺核心中活检Gleason评分≤3+3、PSA密度<0.2且PSA最高水平为15 ng/ml的男性。临床分期必须为T1C或T2。
在患病率筛查中检测出的1014例前列腺癌患者中，293名男性（28.9%）符合积极监测标准。他们的平均年龄为65.7岁，平均PSA水平为4.8 ng/ml。136名男性（46.4%）选择了根治性前列腺切除术，91名（31.1%）选择了放疗，64名（21.8%）选择了观察等待。平均随访时间为80.8个月。八年前列腺癌特异性生存率为99.2%；总生存率为85.4%。19名选择观察等待的男性在随访期间改为确定性治疗。
只有三名男性死于前列腺癌，其中没有一人处于观察等待状态。我们的观察结果为积极监测的任意选择标准提供了初步验证。
