Department of Laboratory Medicine and Pathobiology, University of Toronto, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
Nat Rev Urol. 2013 Aug;10(8):473-82. doi: 10.1038/nrurol.2013.112. Epub 2013 May 28.
Autopsy studies have shown the presence of a large reservoir of latent prostate cancers in adult men. Serum PSA testing of asymptomatic men leads to the detection of a proportion of these latent prostate cancers. The unequivocal demonstration of a substantial (30-50%) risk of overdiagnosis by the two largest randomized population-based screening trials has led to a growing awareness of this unwanted effect. Unsurprisingly, active surveillance is now becoming the favoured strategy for deferring active treatment in men diagnosed with low-risk prostate cancer and reducing their risk of overtreatment. Almost all eligibility criteria for active surveillance refer to a strict pathological definition of insignificant prostate cancer, based on two landmark studies published about 20 years ago. However, current epidemiological data suggest that this original pathological definition of insignificant prostate cancer is too restrictive. In addition, the International Society of Urological Pathology (ISUP) 2005 modification to the Gleason grading system might have resulted in a marked upgrading of biopsy-diagnosed prostate cancers, reducing the number of men eligible for active surveillance. An updated definition of insignificant prostate cancer should reflect the optimal trade-off between reducing the risk of underestimating a significant prostate cancer and including as many men as possible in active surveillance programmes.
尸检研究表明，成年男性的前列腺中存在大量潜伏的前列腺癌。对无症状男性进行血清 PSA 检测会发现其中一部分潜伏的前列腺癌。两项最大的随机人群筛查试验明确证明了过度诊断的风险相当大（30-50%），这导致人们越来越意识到这种不良影响。不出所料，主动监测现在成为诊断为低危前列腺癌的男性推迟主动治疗并降低过度治疗风险的首选策略。几乎所有主动监测的入选标准都指的是基于大约 20 年前发表的两项具有里程碑意义的研究的严格的前列腺癌无意义的病理定义。然而，目前的流行病学数据表明，最初的前列腺癌无意义的病理定义过于严格。此外，国际泌尿病理学会（ISUP）2005 年对格里森分级系统的修改可能导致活检诊断的前列腺癌明显升级，从而减少了适合主动监测的男性人数。前列腺癌无意义的新定义应反映在降低低估有意义的前列腺癌的风险和尽可能多地将男性纳入主动监测计划之间的最佳权衡。
