Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Cancer. 2010 Mar 1;116(5):1281-90. doi: 10.1002/cncr.24882.
Strategies of active surveillance (AS) of low-risk screen-detected prostate cancer have emerged, because the balance between survival outcomes and quality of life issues when radically treating these malignancies is disputable. Delay before radical treatment caused by active surveillance may be associated with an impaired chance of curability.
Men diagnosed with low-risk (T1c/T2; prostate-specific antigen [PSA] = <10.0; PSA density, <0.2 ng/mL; Gleason score, 3 + 3=6; 1-2 positive biopsies) prostate cancer in the Swedish section of the European Randomized Study of Screening for Prostate Cancer who received radical prostatectomy (RP) were studied. One group received immediate RP, whereas another group received delayed RP after an initial period of expectant management. These groups were compared regarding histopathological and biochemical outcomes, correcting for baseline differences.
Mean follow-up after diagnosis was 5.7 years (standard deviation [SD], 3.2). The immediate RP group (n = 158) received RP a mean of 0.5 (SD, 0.2) years after diagnosis; the delayed RP group (n = 69) received RP after 2.6 (SD, 2.0) years (P < .001). After adjustment for small baseline dissimilarities, no differences in RP frequencies of Gleason score >6 (odds ratio [OR], 1.54; P = .221), capsular penetration (OR, 2.45; P = .091), positive margins (OR, 1.34; P = .445), RP tumor volume (difference, 0.099; P = .155), or biochemical progression rates (P = .185, P = .689) were found between groups, although all data were in favor of immediate RP.
With limited patient numbers available for analysis, differences in intermediate outcomes between immediate RP and delayed RP were nonsignificant. The delayed RP group may be subject to a selection bias. Prospective evaluation of active surveillance protocols is essential.
由于根治这些恶性肿瘤的生存结果和生活质量问题之间的平衡存在争议，因此出现了低危筛查前列腺癌的主动监测（AS）策略。主动监测导致的根治性治疗延迟可能会降低治愈的机会。
研究了在瑞典参加欧洲前列腺癌筛查研究的低危（T1c/T2；前列腺特异性抗原[PSA]＜10.0；PSA 密度＜0.2ng/mL；Gleason 评分 3+3=6；1-2 个阳性活检）前列腺癌患者。一组患者接受了根治性前列腺切除术（RP），另一组患者在初始期待管理后接受了延迟 RP。通过校正基线差异，比较了这两组患者的组织病理学和生化结局。
诊断后的平均随访时间为 5.7 年（标准差[SD]，3.2）。立即 RP 组（n=158）在诊断后 0.5（SD，0.2）年接受 RP；延迟 RP 组（n=69）在 2.6（SD，2.0）年后接受 RP（P＜0.001）。在调整了小的基线差异后，两组患者在 Gleason 评分＞6（优势比[OR]，1.54；P=0.221）、包膜穿透（OR，2.45；P=0.091）、阳性切缘（OR，1.34；P=0.445）、RP 肿瘤体积（差异，0.099；P=0.155）或生化进展率（P=0.185，P=0.689）之间没有差异，尽管所有数据都倾向于立即 RP。
由于可用于分析的患者数量有限，立即 RP 和延迟 RP 之间的中期结局差异无统计学意义。延迟 RP 组可能存在选择偏倚。前瞻性评估主动监测方案至关重要。
