Departments of Urology Pathology, Kantonsspital Aarau, Aarau, Switzerland.
BJU Int. 2012 Jul;110(2):195-200. doi: 10.1111/j.1464-410X.2011.10707.x. Epub 2011 Nov 17.
Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? Low-risk prostate cancer is frequently diagnosed in the context of PSA screening or during a routine check-up. For those patients, to avoid possible overtreatment AS is an increasingly chosen treatment option. However, the concept of AS could possibly misclassify potentially dangerous PCa as a low-risk disease resulting in inferior cancer control outcomes. In the present study, we could demonstrate that the histopathological results of patients treated by RP in course of AS are significantly better if the selection criteria for AS are entirely fulfilled. Our findings underline the importance of a strict and precise admittance procedure for patients with early prostate cancer who are willing to undergo an AS programme.
• To compare the histopathological outcomes of patients treated with radical prostatectomy (RP) after an initial active surveillance (AS) for localized, low-risk prostate cancers (PCa) among men who fulfilled the Epstein criteria at diagnosis with those who did not.
• In all, 283 patients with localized PCa were initially managed at our institution with AS. • In all, ≈ 50% originated from the European Randomized Study of Screening for Prostate Cancer (ERSPC) participants from Switzerland: 75 (26.5%) patients underwent treatment during follow-up and 61 were treated with RP (21.6%). • These patients were stratified into those who did (n= 39) vs those who did not (n= 22) entirely fulfil AS inclusion criteria according to Epstein et al. at PCa diagnosis.
• Patients who did completely fulfil the AS inclusion criteria had significantly lower prostate-specific antigen (PSA)-values (4.9 vs 7.8 ng/mL; P= 0.02), a significantly lower PSA density at diagnosis (0.09 vs 0.2 ng/mL/ccm; P= 0.007) and at RP, a higher proportion of organ-confined cancers (89.7% vs 59.1%, P= 0.02) and fewer positive surgical margins (25.6% vs 40.9%). • However, the rate of favourable histopathological outcome, defined as organ-confined disease with negative surgical margins, was statistically significantly higher in the group fulfilling AS criteria (69.2% vs 40.9%; P= 0.03).
• In our AS series, 26.5% of the patients underwent definitive therapy. • Most patients treated with RP had organ-confined disease in the majority of cases, especially when the Epstein criteria were rigorously fulfilled at PCa diagnosis. • This underlines the importance of a strict and precise per protocol AS for patients with early PCa, otherwise there is a risk of missing more significant disease.
• 比较最初接受主动监测（AS）治疗的局限性低危前列腺癌（PCa）患者中，符合 Epstein 标准的患者与不符合 Epstein 标准的患者接受根治性前列腺切除术（RP）后的组织病理学结果。
• 共有 283 例局限性 PCa 患者最初在我院接受 AS 治疗。• 其中约 50%来自瑞士欧洲前列腺癌筛查随机研究（ERSPC）的参与者：75 例（26.5%）患者在随访期间接受治疗，61 例患者接受 RP（21.6%）。• 根据 Epstein 等人的标准，这些患者分为完全符合（n=39）和不符合（n=22）AS 纳入标准的两组。
• 完全符合 AS 纳入标准的患者前列腺特异性抗原（PSA）值显著较低（4.9 vs 7.8ng/mL；P=0.02），诊断时 PSA 密度显著较低（0.09 vs 0.2ng/mL/ccm；P=0.007），RP 时器官局限性癌症的比例较高（89.7% vs 59.1%，P=0.02），阳性切缘率较低（25.6% vs 40.9%）。• 然而，符合 AS 标准的患者中，组织学良好的比例（定义为无阳性切缘的器官局限性疾病）明显较高（69.2% vs 40.9%；P=0.03）。
• 在我们的 AS 系列中，26.5%的患者接受了确定性治疗。• 大多数接受 RP 治疗的患者在大多数情况下都患有器官局限性疾病，尤其是当在 PCa 诊断时严格符合 Epstein 标准时。• 这强调了对于患有早期 PCa 的患者进行严格和精确的符合方案 AS 的重要性，否则可能会错过更严重的疾病。
