Department of Urology, University of California-Davis Medical Center, Sacramento, CA 95817, USA.
Eur Urol. 2012 Dec;62(6):976-83. doi: 10.1016/j.eururo.2012.05.072. Epub 2012 Jun 7.
Prostate cancer (PCa) remains an increasingly common malignancy worldwide. The optimal management of clinically localized, early-stage disease remains unknown, and profound quality of life issues surround PCa interventions.
To systematically summarize the current literature on the management of low-risk PCa with active surveillance (AS), with a focus on patient selection, outcomes, and future research needs.
A comprehensive search of the PubMed and Embase databases from 1980 to 2011 was performed to identify studies pertaining to AS for PCa. The search terms used included prostate cancer and active surveillance or conservative management or watchful waiting or expectant management. Selected studies for outcomes analysis had to provide a comprehensive description of entry characteristics, criteria for surveillance, and indicators for further intervention.
Data from seven large AS series were reviewed. Inclusion criteria for surveillance vary among studies, and eligibility therefore varies considerably (4-82%). PCa-specific mortality remains low (0-1%), with the longest published median follow-up being 6.8 yr. Up to one-third of patients receive secondary therapy after a median of about 2.5 yr of surveillance. Surveillance protocols and triggers for intervention vary among institutions. Most patients are treated for histologic reclassification (27-100%) or prostate-specific antigen doubling time <3 yr (13-48%), while 7-13% are treated with no evidence of progression. Repeat prostate biopsy with a minimum of 12 cores appears to be important for monitoring patients for changes in tumor histology over time.
AS for PCa offers an opportunity to limit intervention to patients who will likely benefit the most from radical treatment. This approach confers a low risk of disease-specific mortality in the short to intermediate term. An early, confirmatory biopsy is essential for limiting the risk of underestimating tumor grade and amount.
前列腺癌（PCa）在全球范围内仍是一种日益常见的恶性肿瘤。对于局限性、早期疾病的最佳治疗方案仍不明确，而且 PCa 干预措施会对患者的生活质量产生深远影响。
系统总结目前关于主动监测（AS）治疗低危 PCa 的文献，重点关注患者选择、结局和未来的研究需求。
对 1980 年至 2011 年间 PubMed 和 Embase 数据库进行全面检索，以确定与 PCa 的 AS 相关的研究。使用的检索词包括前列腺癌和主动监测或保守治疗或观察等待或期待治疗。用于结局分析的入选研究必须全面描述入组特征、监测标准和进一步干预的指标。
综述了 7 项大型 AS 系列研究的数据。各研究的监测纳入标准不同，因此合格患者的范围差异较大（4%-82%）。PCa 特异性死亡率仍较低（0%-1%），最长的中位随访时间为 6.8 年。在中位 2.5 年的监测后，多达三分之一的患者接受了二线治疗。各机构的监测方案和干预触发因素不同。大多数患者因组织学重新分类（27%-100%）或前列腺特异性抗原倍增时间<3 年（13%-48%）而接受治疗，而 7%-13%的患者因无进展而接受治疗。重复前列腺活检，至少 12 个核心，对于监测肿瘤组织学随时间的变化似乎很重要。
PCa 的 AS 为那些最有可能从根治性治疗中获益的患者提供了限制干预的机会。这种方法在短期至中期可使疾病特异性死亡率的风险较低。早期的确认性活检对于限制低估肿瘤分级和数量的风险至关重要。
