University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
J Clin Oncol. 2011 Jan 10;29(2):228-34. doi: 10.1200/JCO.2010.31.4252. Epub 2010 Nov 29.
Active surveillance (AS) is an option for the initial management of early-stage prostate cancer. Current risk stratification schema identify patients with low-risk disease who are presumed to be most suitable for AS. However, some men with higher risk disease also elect AS; outcomes for such men have not been widely reported.
Men managed with AS at University of California, San Francisco, were classified as low- or intermediate-risk based on serum prostate-specific antigen (PSA), Gleason grade, extent of biopsy involvement, and T stage. Clinical and demographic characteristics, and progression in terms of Gleason score, PSA kinetics, and active treatment were compared between men with low- and intermediate-risk tumors.
Compared to men with low-risk tumors, those with intermediate-risk tumors were older (mean, 64.9 v 62.3 years) with higher mean PSA values (10.9 v 5.1 ng/mL), and more tumor involvement (mean, 20.4% v 15.3% positive biopsy cores; all P < .01). Within 4 years of the first positive biopsy, the clinical risk group did not differ in terms of the proportions experiencing progression-free survival, (low [54%] v intermediate [61%]; log-rank P = .22) or the proportions who underwent active treatment (low [30%] v intermediate [35%]; log-rank P = .88). Among men undergoing surgery, none were node positive and none had biochemical recurrence within 3 years.
Selected men with intermediate-risk features be appropriate candidates for AS, and are not necessarily more likely to progress. AS for these men may provide an opportunity to further reduce overtreatment of disease that is unlikely to progress to advanced cancer.
主动监测（AS）是早期前列腺癌初始管理的一种选择。目前的风险分层方案确定了患有低危疾病的患者，这些患者被认为最适合接受 AS。然而，一些患有高危疾病的男性也选择接受 AS；对于这些男性的结果尚未广泛报道。
在加利福尼亚大学旧金山分校接受 AS 治疗的男性根据血清前列腺特异性抗原（PSA）、Gleason 分级、活检累及程度和 T 分期被归类为低危或中危。比较了低危和中危肿瘤患者在临床和人口统计学特征以及 Gleason 评分、PSA 动力学和主动治疗进展方面的差异。
与低危肿瘤患者相比，中危肿瘤患者年龄更大（平均 64.9 岁比 62.3 岁），PSA 值更高（平均 10.9 比 5.1ng/mL），肿瘤累及程度更高（平均 20.4%比 15.3%阳性活检核心；所有 P<.01）。在首次阳性活检后的 4 年内，无进展生存率方面，临床风险组的比例没有差异（低危 [54%] 与中危 [61%]；对数秩 P=.22），或接受主动治疗的比例（低危 [30%] 与中危 [35%]；对数秩 P=.88）。在接受手术的男性中，无淋巴结阳性，无生化复发在 3 年内。
选择具有中危特征的男性适合接受 AS，并且不一定更有可能进展。对这些男性进行 AS 可能为进一步减少不太可能进展为晚期癌症的疾病过度治疗提供机会。
