Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave MG 408, Toronto, M4N 3M5, Ontario, Canada.
Curr Treat Options Oncol. 2013 Mar;14(1):97-108. doi: 10.1007/s11864-012-0221-5.
Low-risk prostate cancer: How I would treat it? Overtreatment of many conditions diagnosed by screening has become increasingly recognized as a contemporary malady associated with modern medicine's efforts at earlier detection. The diagnosis of low-grade prostate cancer clearly qualifies as an example of potential overdiagnosis and overtreatment. Active surveillance for low-risk prostate cancer is an attempt to reduce the overtreatment of the disease. The approach involves initial expectant management rather than immediate therapy. Curative treatment is deferred while the patient is monitored and offered for evidence of risk reclassification to a more aggressive form of the disease. The basis for this approach is substantial evidence confirming the long natural history of most prostate cancers. The objective is to balance the risks of overtreatment and associated adverse quality of life effects, against the risk of progression of disease and a missed opportunity for curative therapy. Low-risk prostate cancer is more accurately viewed as one of several risk factors for the patient harboring higher-grade disease, rather than a life-threatening condition. This approach is similar to that taken historically for so-called precancerous conditions, such as PIN or ASAP, where patients were managed with close follow-up but without radical intervention unless clear evidence of more aggressive disease is identified. Active surveillance is increasingly viewed as the management of choice for patients with very low-risk (low-grade, low-volume prostate cancer) and low-risk (low-grade but higher volume) disease.
我会如何治疗？过度治疗许多通过筛查诊断的疾病已日益被认为是现代医学早期检测努力相关的当代弊病。低级别前列腺癌的诊断显然符合潜在过度诊断和过度治疗的例子。对低危前列腺癌的主动监测是减少该疾病过度治疗的一种尝试。该方法涉及初始的期待性管理，而不是立即进行治疗。在患者被监测并提供疾病风险重新分类为更具侵袭性形式的证据时，推迟了治愈性治疗。这种方法的基础是大量证据证实了大多数前列腺癌的长期自然史。其目的是平衡过度治疗和相关不良生活质量影响的风险，与疾病进展的风险和错过治愈性治疗的机会之间的平衡。低危前列腺癌更准确地被视为患者存在更高级别疾病的几个危险因素之一，而不是危及生命的疾病。这种方法类似于历史上对所谓癌前病变（如 PIN 或 ASAP）所采取的方法，其中患者通过密切随访进行管理，但除非明确发现更具侵袭性的疾病，否则不进行激进干预。主动监测越来越被视为非常低危（低级别、低体积前列腺癌）和低危（低级别但体积较高）疾病患者的治疗选择。
