Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
Nat Rev Clin Oncol. 2010 Jul;7(7):394-400. doi: 10.1038/nrclinonc.2010.63. Epub 2010 May 4.
Testing for prostate-specific antigen (PSA) has caused a dramatic increase in the incidence of prostate cancer during the past two decades. Many cancers identified by repeated PSA testing are small volume, low-grade lesions that pose little threat of progression over 15-20 years. Data from a recently reported randomized trial indicate that as many as 48 men must undergo treatment to prevent one prostate cancer-related death. Unfortunately, no test is currently available that can identify those men who have clinically significant disease. Men least likely to experience disease progression are men who harbor tumors with a Gleason score of 6 involving 2 needle cores or less; these men may want to consider active surveillance as their initial treatment option. Researchers have followed over 2,500 men on active surveillance protocols (over 200 men have been followed for >10 years). To date, prostate cancer-specific survival is over 99%. About 25% of men enrolled in active surveillance programs have abandoned this approach because of concerns about disease progression. For men harboring tumors with a Gleason score >7, data from two recently reported Swedish trials suggest lower prostate cancer-related mortality for those men receiving either surgery or radiation.
在过去的二十年中，前列腺特异性抗原（PSA）检测导致前列腺癌的发病率显著增加。通过重复 PSA 检测发现的许多癌症都是体积小、分级低的病变，在 15-20 年内进展的威胁很小。最近报告的一项随机试验的数据表明，多达 48 名男性必须接受治疗，以预防一例与前列腺癌相关的死亡。不幸的是，目前没有可用于识别那些患有临床显著疾病的男性的测试方法。进展风险最小的男性是那些肿瘤具有格里森评分 6 分、累及 2 个针芯或更少的男性；这些男性可能希望考虑主动监测作为其初始治疗选择。研究人员已经对超过 2500 名接受主动监测方案的男性进行了随访（超过 200 名男性的随访时间超过 10 年）。迄今为止，前列腺癌特异性生存率超过 99%。约 25%的参加主动监测项目的男性因担心疾病进展而放弃了这种方法。对于那些肿瘤格里森评分>7 的男性，最近报告的两项瑞典试验的数据表明，接受手术或放疗的男性前列腺癌相关死亡率较低。
