Jang Thomas L, Yossepowitch Ofer, Bianco Fernando J, Scardino Peter T
Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Urol Oncol. 2007 Nov-Dec;25(6):510-4. doi: 10.1016/j.urolonc.2007.05.025.
The management of low risk prostate cancer, defined as Gleason's sum <or=6, PSA <10 ng/ml, and clinical stage T1c to T2a, remains controversial. There is substantiating evidence to suggest that a subset of early stage, low risk cancers can cause significant patient morbidity and death in the long term. Studies have shown that the natural history of untreated prostate cancer is to progress, particularly after 15 years of followup. The majority of men seeking definitive surgical treatment in contemporary series fall within 55 to 65 years of age and are expected to enjoy an overall life expectancy ranging from about 15 to 30 years, placing these men at long-term risk for disease progression and prostate cancer-specific death if managed expectantly. During the past 2 decades, refinements in surgical technique and in the delivery of external beam radiation have resulted in excellent long-term cancer control and favorable quality of life outcomes following treatment. Active surveillance with selective delayed intervention assumes that an individual's cancer will not progress outside the window of curability during the surveillance period, that markers for disease progression are reliable, and that patients are compliant. Until we understand better the long-term natural history of untreated prostate cancer, have more reliable and accurate markers to detect disease progression with certainty, and can risk stratify more precisely the subgroup of men with low risk cancers who will eventually succumb to their disease, early definitive therapy seems prudent.
低风险前列腺癌的管理仍存在争议，低风险前列腺癌定义为Gleason评分≤6、前列腺特异性抗原（PSA）<10 ng/ml以及临床分期为T1c至T2a。有确凿证据表明，一部分早期低风险癌症从长期来看会导致患者出现严重发病情况并死亡。研究表明，未经治疗的前列腺癌自然病程会进展，尤其是在随访15年后。在当代系列研究中，大多数寻求确定性手术治疗的男性年龄在55至65岁之间，预计总体预期寿命约为15至30年，如果采取观察等待的方式，这些男性面临疾病进展和前列腺癌特异性死亡的长期风险。在过去20年中，手术技术和外照射放疗的改进已带来出色的长期癌症控制效果以及治疗后良好的生活质量结果。主动监测并选择性延迟干预的前提是个体的癌症在监测期内不会在可治愈窗口之外进展、疾病进展的标志物可靠且患者依从。在我们更好地了解未经治疗的前列腺癌的长期自然病程、拥有更可靠准确的标志物以确定疾病进展并且能够更精确地对最终会死于疾病的低风险癌症男性亚组进行风险分层之前，早期确定性治疗似乎是谨慎的做法。
