*Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College †Department of Urology, Thomas Jefferson University, Philadelphia, PA.
Am J Clin Oncol. 2013 Dec;36(6):606-11. doi: 10.1097/COC.0b013e318261056c.
With the widespread use of prostate-specific antigen testing, an increasing number of men are diagnosed with favorable-risk prostate cancer (PC). Recently, emphasis has been placed on active surveillance for selected men with favorable-risk PC to avoid unnecessary treatment for tumors that may be clinically insignificant. We performed a population-based analysis to assess patterns of initial treatment (IT) for a contemporary cohort of elderly men diagnosed with a favorable-risk PC in the United States.
We used the Surveillance, Epidemiology, and End Results database to identify men aged more than or equal to 70 years diagnosed with a favorable-risk PC from 2004 to 2008. Multivariable logistic regression analyses were performed to determine patient, tumor, and socioeconomic factors associated with IT.
A total of 15,108 men more than or equal to 70 years with a favorable-risk PC were identified. Prostatectomy was performed in 2.6% of patients. Fifty-nine percent of patients were recommended to undergo radiation therapy (RT). Among patients 70 to 74 years, 66.45% were recommended to undergo RT. Fifty-nine percent, 36.6%, and 15.8% of patients between 75 and 79, 80 and 84, and more than or equal to 85 years were recommended to receive RT, respectively. Factors significantly associated with IT on multivariable logistic regression analysis included: younger age, white race, Gleason Score 6 (vs.≤5), married marital status, and no history of prior malignancy. We also identified significant geographic variations in patterns of IT.
A large percentage of elderly men diagnosed with favorable-risk PC undergo IT, most commonly with RT. Future research should be performed to identify barriers to patient and physician acceptance of active surveillance.
随着前列腺特异性抗原检测的广泛应用，越来越多的男性被诊断为低危前列腺癌（PC）。最近，人们越来越关注对具有低危 PC 的特定男性进行积极监测，以避免对可能临床意义不大的肿瘤进行不必要的治疗。我们进行了一项基于人群的分析，以评估在美国诊断为低危 PC 的老年男性的初始治疗（IT）模式。
我们使用监测、流行病学和最终结果数据库，确定了 2004 年至 2008 年期间年龄大于或等于 70 岁的患有低危 PC 的男性。多变量逻辑回归分析用于确定与 IT 相关的患者、肿瘤和社会经济因素。
共确定了 15108 名年龄大于或等于 70 岁且患有低危 PC 的男性。前列腺切除术在 2.6%的患者中进行。59%的患者建议进行放射治疗（RT）。在 70 至 74 岁的患者中，66.45%的患者建议进行 RT。59%、36.6%和 15.8%的 75 至 79 岁、80 至 84 岁和 85 岁及以上的患者分别被建议接受 RT。多变量逻辑回归分析中与 IT 显著相关的因素包括：年龄较小、白人种族、Gleason 评分 6（与≤5 相比）、已婚婚姻状况和无既往恶性肿瘤史。我们还发现 IT 模式存在显著的地域差异。
很大比例的被诊断为低危 PC 的老年男性接受了 IT，最常见的是 RT。未来的研究应针对患者和医生接受主动监测的障碍进行。
