Graefen M, Ahyai S, Heuer R, Salomon G, Schlomm T, Isbarn H, Budäus L, Heinzer H, Huland H
Martini-Klinik, Prostatazentrum an der Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany.
Urologe A. 2008 Mar;47(3):261-9. doi: 10.1007/s00120-008-1638-0.
Active surveillance is a valuable treatment option in patients with newly diagnosed low-risk prostate cancer. Studies considering a watchful waiting approach showed favourable cancer-specific survival rates in such patients and it is assumed that patients benefit from a definitive therapy if life expectancy exceeds 10-15 years. Therefore active surveillance is especially valuable in older men and in patients with an elevated comorbidity profile. Precise identification of histologically and clinically insignificant prostate cancers is still not possible today. Active surveillance includes regular PSA measurements combined with follow-up biopsies; however, no standardized protocol exists so far. Histological progression in the follow-up biopsy and PSA elevation are the most important criteria for initiating definitive therapy. Today only a minority of low-risk patients join an active surveillance protocol and a substantial proportion of these men leave such a protocol early without evidence of progression. The psychological burden of living with an untreated cancer seems to be responsible for this. Active surveillance has the potential to lead to undertreatment as there is some evidence that prolonged treatment delay might adversely affect outcome of definitive therapy.
主动监测是新诊断的低风险前列腺癌患者的一种有价值的治疗选择。考虑采用观察等待方法的研究表明，此类患者的癌症特异性生存率良好，并且假定如果预期寿命超过10至15年，患者将从确定性治疗中获益。因此，主动监测在老年男性和合并症较多的患者中尤其有价值。目前仍无法精确识别组织学和临床上无意义的前列腺癌。主动监测包括定期进行前列腺特异性抗原（PSA）检测并结合随访活检；然而，迄今为止尚无标准化方案。随访活检中的组织学进展和PSA升高是启动确定性治疗的最重要标准。如今，只有少数低风险患者加入主动监测方案，而且这些男性中有很大一部分在没有进展证据的情况下早早退出该方案。未治疗癌症带来的心理负担似乎是造成这种情况的原因。主动监测有可能导致治疗不足，因为有证据表明，延长治疗延迟可能会对确定性治疗的结果产生不利影响。
