University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
Acta Oncol. 2011 Jun;50 Suppl 1:120-6. doi: 10.3109/0284186X.2010.526634.
The incidence of prostate cancer has increased dramatically worldwide during the past few decades in part because of increased testing for prostate specific antigen (PSA). The aggressive use of this screening tool has resulted in the identification of many localized prostate cancers a majority of which are relatively low volume, low grade tumors. Older autopsy studies have documented that incidental prostate cancer is quite common especially in older men. The finasteride chemoprevention trial confirmed these findings. Many prostate cancers are not destined to progress to clinically significant tumors. Several case series have documented the natural history of clinically detected prostate cancer. The progression of disease identified by PSA testing is less certain. These studies uniformly show that many men with low grade tumors can survive for over two decades in the absence of treatment. Furthermore, randomized clinical trials have shown only a modest ten year survival advantage for those men undergoing either surgery or radiation.
As a consequence, men with low risk of disease progression may wish to consider active surveillance as a treatment option. To date, several case series have documented that men following an active surveillance protocol that includes regular PSA testing and periodic re-biopsy have an excellent outcome. The majority of these men have not demonstrated evidence of progression during the first decade of follow-up and among those that have the majority have undergone either surgery or radiation without compromise of their long-term outcome. Unfortunately, until better biomarkers become available, the outcome of any individual patient defies accurate prediction.
Men with newly diagnosed prostate cancer must weigh the risk of disease progression against the potential efficacy and safety of treatment when making a decision whether to consider active surveillance as an appropriate treatment.
在过去几十年中，全球范围内前列腺癌的发病率急剧上升，部分原因是前列腺特异性抗原（PSA）检测的增加。这种筛查工具的广泛使用导致了许多局限性前列腺癌的发现，其中大多数肿瘤体积较小，分级较低。早期的尸检研究已经证明，偶然发现的前列腺癌非常常见，尤其是在老年男性中。非那雄胺化学预防试验证实了这些发现。许多前列腺癌不会发展为具有临床意义的肿瘤。有几项病例系列研究记录了临床检测到的前列腺癌的自然史。通过 PSA 检测识别出的疾病进展并不确定。这些研究一致表明，许多低分级肿瘤的男性在没有治疗的情况下可以存活超过二十年。此外，随机临床试验仅表明，接受手术或放疗的男性的十年生存率略有提高。
因此，疾病进展风险低的男性可能希望考虑主动监测作为一种治疗选择。迄今为止，有几项病例系列研究记录了遵循包括定期 PSA 检测和定期重新活检的主动监测方案的男性具有极好的结果。这些男性中的大多数在随访的第一个十年中没有显示出进展的迹象，而在那些有进展迹象的男性中，大多数男性已经接受了手术或放疗，而不会影响他们的长期预后。不幸的是，在更好的生物标志物出现之前，任何个体患者的预后都难以准确预测。
新诊断为前列腺癌的男性在决定是否将主动监测作为适当的治疗方法时，必须权衡疾病进展的风险与治疗的潜在疗效和安全性。
