Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, CD 20307, USA.
Urol Oncol. 2013 Aug;31(6):755-60. doi: 10.1016/j.urolonc.2011.07.004. Epub 2011 Aug 26.
Prostate cancer (CaP) in the aging male will become an increasingly important and controversial health care issue. We evaluated the outcomes between a variety of treatments for low-risk CaP in patients 70 years of age and older.
A total of 3,650 men diagnosed with CaP between 1989 and 2009 were identified in the Center for Prostate Disease Research database to be 70 years of age or older at time of diagnosis. Of these patients, 770 men met the D'Amico criteria ([13]) for low-risk disease and were treated with radical prostatectomy, external beam radiation therapy, or watchful waiting. Cox proportional hazard models were used to compare clinicopathologic features across treatment groups. Kaplan-Meier analysis was used to compare biochemical recurrence-free, progression-free, and overall survival.
Of the 770 patient cohort, 194 (25%) chose radical prostatectomy, 252 (33%) chose external beam radiation therapy, and 324 (42%) were initially managed by watchful waiting with 110 (34%) of this subset ultimately undergoing secondary treatment. The median follow-up was 6.4 years. There were no significant differences in distributions of race/ethnicity, number of medical comorbidities, or clinical stage across the treatment groups. Patients managed on watchful waiting without secondary treatment had the poorest overall survival on Kaplan-Meier analysis (P = 0.0001). Additionally, multivariate analysis confirmed this result for watchful waiting without secondary treatment as being a statistically significant predictor of overall mortality (HR 1.938, P = 0.0084).
老年男性的前列腺癌（CaP）将成为一个日益重要且颇具争议的医疗保健问题。我们评估了各种治疗方法在 70 岁及以上低危 CaP 患者中的疗效。
在前列腺疾病研究中心数据库中，我们共确定了 1989 年至 2009 年间被诊断为 CaP 的 3650 名年龄在 70 岁或以上的男性患者。在这些患者中，770 名符合低危疾病的 D'Amico 标准[13]，并接受了根治性前列腺切除术、外照射放疗或观察等待治疗。使用 Cox 比例风险模型比较了治疗组之间的临床病理特征。Kaplan-Meier 分析用于比较生化无复发生存率、无进展生存率和总生存率。
在 770 名患者队列中，194 名（25%）选择了根治性前列腺切除术，252 名（33%）选择了外照射放疗，324 名（42%）最初接受观察等待治疗，其中 110 名（34%）最终接受了二线治疗。中位随访时间为 6.4 年。在治疗组之间，种族/民族分布、医疗合并症数量或临床分期没有显著差异。在 Kaplan-Meier 分析中，未接受二线治疗的观察等待组的总生存率最差（P = 0.0001）。此外，多变量分析证实，未接受二线治疗的观察等待是总死亡率的统计学显著预测因素（HR 1.938，P = 0.0084）。
