Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
BJU Int. 2011 May;107(10):1582-6. doi: 10.1111/j.1464-410X.2010.09652.x. Epub 2010 Sep 22.
• To report outcomes for patients with localized prostate cancer managed using a watchful waiting strategy at an American centre and to explore factors that have triggered intervention.
• From 1991 to 2005, 218 patients diagnosed with untreated localized prostate cancer were followed at Massachusetts General Hospital with prostate-specific antigen (PSA) monitoring and digital rectal examination (DRE). Re-biopsies were performed in 95 of the patients. • The median follow-up was 6.3 years. Clinical outcomes and features predicting intervention were examined.
• At diagnosis, the median PSA level was 5.4 ng/mL. The Gleason score (GS) distribution was as follows: 95% with GS 6, 4% with GS 7, 1% with GS 8. The clinical T-stage distribution was as follows: 6% with T1a-b, 84% with T1c, 10% with T2. The median age was 71 years. • At 10 years, the overall survival was 79%, the cause-specific survival was 100%, the rate of distant metastasis was 5%, the rate of salvage androgen deprivation therapy was 15% and the rate of freedom from intervention (FFI) was 70%. • There was a PSA velocity of ≥ 2 ng/mL per year in 16% of patients, and a PSA doubling time of ≤ 3 years in 15% of patients. • Among the 95 re-biopsied men, the GS increased (grade progression) in 25% and the percentage of positive cores increased (volume progression) in 33%. • On multivariate analysis, only PSA doubling time and volume progression were independent predictors of FFI.
• In the present series, watchful waiting was associated with low rates of intervention and cancer progression. • As PSA doubling time and volume progression were the main triggers for intervention, these will be incorporated into the centre's current active surveillance protocol.
报告在美国一家中心采用观察等待策略治疗局限性前列腺癌患者的结果，并探讨触发干预的因素。
1991 年至 2005 年，218 名未接受治疗的局限性前列腺癌患者在马萨诸塞州综合医院接受前列腺特异性抗原（PSA）监测和数字直肠检查（DRE）随访。95 名患者接受了再活检。中位随访时间为 6.3 年。检查了临床结果和预测干预的特征。
诊断时，中位 PSA 水平为 5.4ng/ml。Gleason 评分（GS）分布如下：95%为 GS 6，4%为 GS 7，1%为 GS 8。临床 T 分期分布如下：6%为 T1a-b，84%为 T1c，10%为 T2。中位年龄为 71 岁。10 年时，总生存率为 79%，特异性生存率为 100%，远处转移率为 5%，挽救性去势治疗率为 15%，无干预生存率（FFI）为 70%。16%的患者 PSA 速度≥2ng/ml/年，15%的患者 PSA 倍增时间≤3 年。95 名再次活检的男性中，25%的 GS 升高（分级进展），33%的阳性核心比例增加（体积进展）。多变量分析显示，只有 PSA 倍增时间和体积进展是 FFI 的独立预测因素。
在本系列中，观察等待与低干预率和癌症进展相关。由于 PSA 倍增时间和体积进展是干预的主要触发因素，这些因素将被纳入该中心当前的主动监测方案。
