Bastian Patrick J, Carter Ballentine H, Bjartell Anders, Seitz Michael, Stanislaus Peter, Montorsi Francesco, Stief Christian G, Schröder Fritz
Urologische Klinik und Poliklinik, Universitätsklinikun der Universität München - Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany.
Eur Urol. 2009 Jun;55(6):1321-30. doi: 10.1016/j.eururo.2009.02.028. Epub 2009 Mar 6.
Due to early detection strategies, prostate cancer is diagnosed early in its natural history. It remains unclear whether all patients diagnosed with prostate cancer warrant radical treatment or may benefit from delayed intervention following active surveillance.
A systematic review of active surveillance protocols to investigate the inclusion criteria for active surveillance and the outcome of treatment.
Medline was searched using the following terms: prostate cancer, active surveillance and expectant management for dates up to October 2008. Further studies were chosen on the basis of manual searches of reference lists and review papers.
Numerous studies on active surveillance were identified. The recent inclusion criteria of the studies are rather similar. Keeping the short follow-up of all studies in mind, the majority of men stay on active surveillance, and the percentage of patients receiving active treatment is as high as 35% of all patients. Once a patients requires active treatment, most patients still present with curable prostate cancer. Furthermore, only few deaths due to prostate cancer have occurred.
Active surveillance is an alternative option to immediate treatment of men with presumed insignificant prostate cancer. It seems that criteria used to identify men with low-risk prostate cancer are rather similar, and immediate treatment of men meeting these criteria may result in an unnecessary number of treatments in these highly selected patients. Data from randomised trials comparing active surveillance and active treatment will provide additional insight into outcome and follow-up strategies.
由于早期检测策略，前列腺癌在其自然病程中得以早期诊断。目前仍不清楚所有被诊断为前列腺癌的患者是否都需要进行根治性治疗，或者在积极监测后延迟干预是否会使其受益。
对积极监测方案进行系统评价，以研究积极监测的纳入标准和治疗结果。
使用以下检索词在Medline数据库中进行检索：前列腺癌、积极监测和期待性管理，检索截至2008年10月的文献。基于对参考文献列表和综述文章的手动检索，选择了更多研究。
确定了大量关于积极监测的研究。近期研究的纳入标准相当相似。考虑到所有研究的随访时间较短，大多数男性仍处于积极监测状态，接受积极治疗的患者比例高达所有患者的35%。一旦患者需要积极治疗，大多数患者仍表现为可治愈的前列腺癌。此外，因前列腺癌导致的死亡病例很少。
对于推定前列腺癌不严重的男性，积极监测是立即治疗的一种替代选择。似乎用于识别低风险前列腺癌男性的标准相当相似，对符合这些标准的男性立即进行治疗可能会导致在这些高度选择的患者中进行不必要的治疗。比较积极监测和积极治疗的随机试验数据将为结果和随访策略提供更多见解。
