Soloway Mark S, Soloway Cynthia T, Williams Steve, Ayyathurai Rajinikanth, Kava Bruce, Manoharan Murugesan
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
BJU Int. 2008 Jan;101(2):165-9. doi: 10.1111/j.1464-410X.2007.07190.x. Epub 2007 Sep 10.
To examine the outcome of patients diagnosed with 'low-risk' prostate cancer managed by active surveillance (AS).
In all, 157 men with localized prostate cancer were followed on AS. The inclusion criteria for AS included: Gleason score of < or = 6, a serum prostate-specific antigen (PSA) level of < or = 15 ng/mL, stage < or = T2, low-volume disease and > 12 months of follow-up. The follow-up was rigorous, with PSA tests and a digital rectal examination every 3 months for 2 years, and a repeat biopsy 6-12 months after the initial diagnosis and yearly when indicated. Continuance of AS was based on the PSA doubling time, re-biopsy score, Gleason score, tumour volume, stage progression and patient preference.
In all 99 patients met the inclusion criteria; their mean age at diagnosis was 66 years, their mean PSA level 5.77 ng/mL and the mean follow-up 45.3 months. On initial repeat biopsy, 63% had no cancer and 34% had a Gleason sum of < or = 6. Eight patients were treated (three with hormones; five with curative intent); two had radical prostatectomy (one had pT2c pNO Gleason 7 disease); three had radiotherapy. The probability is that 85% would remain treatment-free at 5 years; no patient died from prostate cancer. The PSA doubling time and clinical stage at diagnosis were predictive of progression.
Patients who are followed on AS must be selected using narrowly defined inclusion criteria and closely followed with a standard regimen of PSA testing, digital rectal examination and repeat biopsy.
研究经主动监测（AS）管理的被诊断为“低风险”前列腺癌患者的预后情况。
共有157例局限性前列腺癌男性患者接受主动监测。主动监测的纳入标准包括：Gleason评分≤6分、血清前列腺特异性抗原（PSA）水平≤15 ng/mL、分期≤T2、低瘤体量以及随访时间>12个月。随访严格，在2年内每3个月进行一次PSA检测和直肠指检，在初始诊断后6 - 12个月重复活检，必要时每年进行一次。主动监测的持续进行基于PSA倍增时间、再次活检评分、Gleason评分、肿瘤体积、分期进展以及患者偏好。
共有99例患者符合纳入标准；他们诊断时的平均年龄为66岁，平均PSA水平为5.77 ng/mL，平均随访时间为45.3个月。初次重复活检时，63%的患者无癌，34%的患者Gleason总分≤6分。8例患者接受了治疗（3例接受激素治疗；5例有治愈意图）；2例行根治性前列腺切除术（1例为pT2c pNO Gleason 7期疾病）；3例接受放疗。5年时85%的患者可能无需接受治疗；无患者死于前列腺癌。诊断时的PSA倍增时间和临床分期可预测疾病进展。
接受主动监测的患者必须使用严格定义的纳入标准进行选择，并通过PSA检测、直肠指检和重复活检的标准方案进行密切随访。
