Dall'Era Marc A, Konety Badrinath R
Department of Urology, University of California, San Francisco, CA 94143-1695, USA.
Nat Clin Pract Urol. 2008 May;5(5):277-83. doi: 10.1038/ncpuro1058. Epub 2008 Feb 19.
The natural history of prostate cancer is often of long duration, and the disease is incompletely understood. Whether all men with prostate cancer require immediate treatment or whether men with tumors of low malignant potential are being overtreated with potentially harmful therapies is a subject of much debate. Results from a randomized trial that compared watchful waiting and active therapy showed all-cause and disease-specific survival advantages with radical therapy, but the study group was mixed in terms of disease risk; the optimum treatment strategy for men with low risk features remains unclear. Multiple centers are gaining experience with active surveillance and delayed intervention with curative intent for men with prostate tumors of potentially low clinical risk. This Review describes the background studies behind the rationale for active surveillance, thoughts on selection criteria for candidates and some early reported outcomes for active surveillance cohorts. The psychosocial impact of active surveillance on patients is discussed as well as contemporary methods for disease monitoring.
前列腺癌的自然病程通常较长，人们对这种疾病的了解并不全面。所有前列腺癌患者是否都需要立即接受治疗，或者低恶性潜能肿瘤患者是否正在接受可能有害的过度治疗，这是一个备受争议的话题。一项比较观察等待和积极治疗的随机试验结果显示，根治性治疗在全因生存率和疾病特异性生存率方面具有优势，但研究组在疾病风险方面存在差异；低风险特征男性的最佳治疗策略仍不明确。多个中心正在积累经验，对临床风险可能较低的前列腺肿瘤男性进行积极监测并延迟进行有治愈意图的干预。本综述描述了积极监测理论依据背后的背景研究、对候选者选择标准的思考以及积极监测队列的一些早期报告结果。还讨论了积极监测对患者的心理社会影响以及疾病监测的当代方法。
