前列腺特异性抗原和即刻确认性活检在预测低危前列腺癌主动监测中进展的作用。
Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer.
机构信息
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
出版信息
J Urol. 2011 Feb;185(2):477-82. doi: 10.1016/j.juro.2010.09.095. Epub 2010 Dec 17.
PURPOSE
We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy.
MATERIALS AND METHODS
A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion.
RESULTS
Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.14-1.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.01-3.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.41-7.09, p = 0.005).
CONCLUSIONS
Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirmatory biopsy to better assess the risk of progression.
目的
我们评估了开始主动监测后进展的预测因素，特别是前列腺特异性抗原（PSA）和即刻确认性前列腺活检的作用。
材料与方法
共有 238 名符合主动监测条件的前列腺癌患者进行了时间分析，以评估进展情况。使用 Cox 比例风险回归评估进展的预测因素。使用 2 种定义评估进展，包括不再满足 1）完整标准和 2）修改标准，不将 PSA 大于 10ng/ml 作为标准。
结果
使用完整标准，238 名患者中有 61 名在随访期间发生进展。2 年和 5 年无进展生存率分别为 80%和 60%。将 PSA 纳入进展标准后，确认性活检时的 PSA（HR 1.29，95%CI 1.14-1.46，p<0.0005）和阳性确认性活检（HR 1.75，95%CI 1.01-3.04，p=0.047）是进展的独立预测因素。在 61 例失败病例中，34 例因 PSA 升高而失败，其中只有 5 例随后通过活检标准进展。当 PSA 从进展标准中排除时，只有 32 例进展，2 年和 5 年无进展生存率分别为 91%和 76%。使用修改标准作为终点，阳性确认性活检是进展的唯一独立预测因素（HR 3.16，95%CI 1.41-7.09，p=0.005）。
结论
低危前列腺癌患者可行主动监测，大多数患者在 5 年内进展证据很少。在没有肿瘤进展其他迹象的情况下，PSA 升高至 10ng/ml 以上的患者没有明确的治疗理由。考虑主动监测的患者应进行确认性活检，以更好地评估进展风险。
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