Stattin Pär, Holmberg Erik, Bratt Ola, Adolfsson Jan, Johansson Jan-Erik, Hugosson Jonas
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umea, Sweden.
J Urol. 2008 Dec;180(6):2423-9; discussion 2429-30. doi: 10.1016/j.juro.2008.08.044. Epub 2008 Oct 18.
To what extent active surveillance and deferred treatment for localized risk prostate cancer are used is unclear. We assessed the use of surveillance and of deferred treatment in a population based, nationwide cohort in Sweden.
In the National Prostate Cancer Register of Sweden, with a 98% coverage vs the compulsory Swedish Cancer Registry, we identified 8,304 incident cases of prostate cancer in 1997 to 2002 with age younger than 70 years, clinical local stage T1 or 2, N0 or Nx, M0 or Mx and serum prostate specific antigen less than 20 ng/ml. Data were extracted from medical charts for 7,782 of these men (94%) at a median of 4 years after diagnosis.
Primary treatment was surveillance for 2,065 men (26%), radical prostatectomy for 3,722 (48%), radiotherapy for 1,632 (21%) and hormonal treatment for 363 (5%). Men on surveillance had lower local tumor stage, grade and prostate specific antigen, and were older than those who received active primary treatment (p <0.001). After a median surveillance of 4 years 711 men (34%) on surveillance had received deferred treatment, which was radical prostatectomy for 279 (39%), radiotherapy for 212 (30%) and hormonal treatment for 220 (30%).
Surveillance was a common treatment for patients younger than 70 years with localized prostate cancer in Sweden in 1997 to 2002, 26% of men with localized prostate cancer started surveillance and after a median followup of 4 years, 66% of these men remained on surveillance.
目前尚不清楚对局限性高危前列腺癌进行主动监测和延迟治疗的应用程度。我们在瑞典全国范围内基于人群的队列中评估了监测和延迟治疗的使用情况。
在瑞典国家前列腺癌登记处（其与瑞典强制性癌症登记处的覆盖率为98%）中，我们识别出1997年至2002年年龄小于70岁、临床局部分期为T1或2、N0或Nx、M0或Mx且血清前列腺特异性抗原小于20 ng/ml的8304例前列腺癌新发病例。在诊断后中位4年时，从其中7782名男性（94%）的病历中提取数据。
2065名男性（26%）接受的初始治疗为监测，3722名（48%）接受根治性前列腺切除术，1632名（21%）接受放疗，363名（5%）接受激素治疗。接受监测的男性局部肿瘤分期、分级和前列腺特异性抗原较低，且年龄大于接受积极初始治疗的男性（p<0.001）。在中位监测4年后，711名接受监测的男性（34%）接受了延迟治疗，其中279名（39%）接受根治性前列腺切除术，212名（30%）接受放疗，220名（30%）接受激素治疗。
在1997年至2002年的瑞典，监测是70岁以下局限性前列腺癌患者的常见治疗方式，26%的局限性前列腺癌男性开始接受监测，中位随访4年后，这些男性中有66%仍在接受监测。
