Prostate Oncology Specialists, Prostate Institute of America, University of California at Los Angeles, Ashland Community Hospital, Marina del Rey, CA 90292, USA.
Prostate. 2013 Jan;73(1):83-8. doi: 10.1002/pros.22543. Epub 2012 Jul 2.
Active surveillance (AS) is only recommended for Low-Risk prostate cancer (PC) with <34% biopsies positive. Studies describing the long-term outcome of men treated with androgen deprivation (AD) followed by AS are sparse.
One hundred two men were treated with 12 months of AD in a medical oncology clinic specializing in PC between 1998 and 2007 and were followed for a median of 7.25 years. The biopsy complete response rate after AD and the incidence of disease progression while on subsequent AS was assessed. Baseline age, D'Amico risk category, PSA velocity, percentage core biopsies, and prostate volume were evaluated as potential predictors of disease progression.
D'Amico risk category for the 102 men: Low: n = 22, Intermediate: n = 30, and High: n = 50. Medians: Age 67.3, PSA 7.8, Gleason 3 + 4, >50% core biopsies positive, stage T1c. Seventy men had a clear biopsy and 31 of these had disease progression leading to additional treatment after a median of 52 months. D'Amico risk category of the 57 men with a positive biopsy after AD or disease progression on AS was: Low: n = 4 (18%), Intermediate: n = 16 (53%), and High: n = 37 (74%). No PC deaths occurred. Three men had clinical progression. In stepwise logistic regression analysis only higher D'Amico risk category and lower prostate volume predicted disease progression.
Despite a high prevalence of ≥50% core biopsies positive at baseline, AD induces durable remissions in most men with Low-Risk and about half with Intermediate-Risk PC.
主动监测（AS）仅推荐用于活检阳性率<34%的低危前列腺癌（PC）。描述接受雄激素剥夺（AD）治疗后再行 AS 治疗的男性长期结局的研究很少。
1998 年至 2007 年间，一家专门从事 PC 治疗的医学肿瘤学诊所对 102 名男性进行了为期 12 个月的 AD 治疗，并对其进行了中位 7.25 年的随访。评估 AD 后活检完全缓解率和后续 AS 时疾病进展的发生率。评估基线年龄、D'Amico 风险类别、PSA 速度、核心活检百分比和前列腺体积作为疾病进展的潜在预测因素。
102 名男性的 D'Amico 风险类别：低危：n = 22，中危：n = 30，高危：n = 50。中位数：年龄 67.3，PSA 7.8，Gleason 3 + 4，>50%核心活检阳性，T1c 期。70 名男性有明确的活检结果，其中 31 名在 AD 后出现疾病进展或 AS 时出现疾病进展，导致中位 52 个月后需要额外治疗。57 名 AD 后活检阳性或 AS 时疾病进展男性的 D'Amico 风险类别：低危：n = 4（18%），中危：n = 16（53%），高危：n = 37（74%）。没有 PC 死亡。3 名男性出现临床进展。逐步逻辑回归分析显示，只有更高的 D'Amico 风险类别和更低的前列腺体积预测疾病进展。
尽管基线时大多数核心活检阳性率>50%，但 AD 可诱导大多数低危和约一半中危 PC 男性的持久缓解。
