Busch Jonas, Magheli Ahmed, Leva Natalia, Ferrari Michelle, Kramer Juergen, Klopf Christian, Kempkensteffen Carsten, Miller Kurt, Brooks James D, Gonzalgo Mark L
Department of Urology, Charité University Medicine, Berlin, Germany.
BJU Int. 2014 Oct;114(4):517-21. doi: 10.1111/bju.12466. Epub 2014 Jan 22.
To determine pathological and oncological outcomes of patients diagnosed with low-risk prostate cancer in two age cohorts who underwent radical prostatectomy (RP) and qualified for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, as AS for low-risk prostate cancer represents an acceptable management strategy especially for older patients.
In all, 320 patients aged ≥65 years who underwent RP and were eligible for AS according to PRIAS criteria were propensity score matched 1:1 to patients aged <65 years. Patient characteristics were compared with chi-square, Kruskal-Wallis, and one-way anova tests. Predictors of RP pathological upgrading or upstaging were analysed using logistic regression. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Predictors of RFS were analysed within Cox regression models.
Pathological upgrading and upstaging were significantly higher among older (≥65 years) vs younger (<65 years) patients (53.1% vs 44.1% and 12.2% vs 7.2%, respectively). Higher prostate-specific antigen levels and increasing age were independent predictors of upgrading among patients aged <65 years. There were no differences in RFS or OS between the two age groups. Positive surgical margin status was the only independent predictor of shorter RFS.
Patients aged ≥65 years who are eligible for AS by PRIAS criteria have a higher risk of being upgraded and upstaged at RP than those aged <65 years. These findings should be taken into consideration when discussing treatment options for patients diagnosed with prostate cancer.
根据国际前列腺癌研究组织：主动监测（PRIAS）标准，确定两个年龄队列中被诊断为低风险前列腺癌且接受了根治性前列腺切除术（RP）并符合主动监测（AS）条件的患者的病理和肿瘤学结局，因为低风险前列腺癌的主动监测是一种可接受的管理策略，尤其对于老年患者。
总共320例年龄≥65岁且接受了RP并根据PRIAS标准符合主动监测条件的患者，按倾向评分1:1与年龄<65岁的患者进行匹配。使用卡方检验、Kruskal-Wallis检验和单因素方差分析对患者特征进行比较。使用逻辑回归分析RP病理升级或分期上升的预测因素。采用Kaplan-Meier法计算无复发生存期（RFS）和总生存期（OS）。在Cox回归模型中分析RFS的预测因素。
老年（≥65岁）患者的病理升级和分期上升显著高于年轻（<65岁）患者（分别为53.1%对44.1%和12.2%对7.2%）。年龄<65岁的患者中，较高的前列腺特异性抗原水平和年龄增长是升级的独立预测因素。两个年龄组之间的RFS或OS无差异。手术切缘阳性状态是RFS较短的唯一独立预测因素。
根据PRIAS标准符合主动监测条件的≥65岁患者在RP时发生升级和分期上升的风险高于<65岁的患者。在讨论前列腺癌诊断患者的治疗方案时应考虑这些发现。
