Department of Urology, The Johns Hopkins University School of Medicine and The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
J Urol. 2010 May;183(5):1779-85. doi: 10.1016/j.juro.2010.01.001. Epub 2010 Mar 20.
We sought to predict biopsy progression in men on prostate cancer surveillance.
A total of 376 men with a median age of 65.5 years (range 45.8 to 79.5) with low risk prostate cancer on surveillance underwent at least 1 followup biopsy after diagnosis. Progression was defined at surveillance biopsy as Gleason pattern 4 or 5, greater than 2 biopsy cores with cancer or greater than 50% involvement of any core with cancer. Proportional hazards analysis was used to evaluate the association between covariates and progression at surveillance biopsy. The Kaplan-Meier method was used to estimate the probability of disease progression.
Of the 376 men 123 (32.7%) had progression a median of 5.6 years (range 0.3 to 8.5) after diagnosis. Percent free PSA and maximum percent core involvement at diagnosis were associated with progression, allowing stratification of the progression risk at initial surveillance biopsy. Cancer presence and PSA density at initial surveillance biopsy were associated with subsequent progression, allowing stratification of the cumulative incidence of progression 3 years after initial surveillance biopsy (cumulative incidence 11.1%, 95% CI 4.7 to 25.2 for negative biopsy and PSAD less than 0.08 ng/ml/cm(3) vs 53.6%, 95% CI 38.6 to 70.0 for positive biopsy and PSAD 0.08 ng/ml/cm(3) or greater, log rank test p <0.0001).
Clinical variables at diagnosis and at first surveillance biopsy during followup in an active surveillance program can be used to inform men about the likelihood of an unfavorable prostate biopsy. This information could improve patient and physician acceptance of active surveillance in carefully selected men.
我们旨在预测接受前列腺癌监测男性的活检进展。
共有 376 名中位年龄为 65.5 岁（范围为 45.8 至 79.5）的低危前列腺癌男性患者在诊断后至少进行了一次后续活检。在监测活检中，进展定义为 Gleason 模式 4 或 5、2 个以上活检核心有癌或任何核心的癌累及超过 50%。比例风险分析用于评估协变量与监测活检进展之间的关联。Kaplan-Meier 法用于估计疾病进展的概率。
在 376 名男性中，123 名（32.7%）在诊断后中位 5.6 年（范围 0.3 至 8.5）时出现进展。初始诊断时游离前列腺特异性抗原百分比和最大核心受累百分比与进展相关，允许在初始监测活检时对进展风险进行分层。初始监测活检时的癌症存在和 PSA 密度与后续进展相关，允许在初始监测活检后 3 年对进展累积发生率进行分层（累积发生率为阴性活检和 PSA 密度小于 0.08ng/ml/cm³的患者为 11.1%，95%CI 4.7 至 25.2；阳性活检和 PSA 密度为 0.08ng/ml/cm³或更高的患者为 53.6%，95%CI 38.6 至 70.0，对数秩检验 p<0.0001）。
在主动监测期间，诊断时和首次监测活检时的临床变量可用于告知男性不利前列腺活检的可能性。这些信息可以提高在精心挑选的男性中对主动监测的患者和医生的接受程度。
