Azmi A, Dillon R A, Borghesi S, Dunne M, Power R E, Marignol L, O'Neill B D P
St. Luke's Radiation Oncology Centre, Beaumont Hospital, Dublin, Ireland,
Ir J Med Sci. 2015 Jun;184(2):305-11. doi: 10.1007/s11845-014-1104-5. Epub 2014 Mar 21.
Active surveillance (AS) is a recognised treatment option for low-risk prostate cancer (PCa).
To review AS criteria in terms of patient selection, follow-up and indications for intervention.
A total of 2,959 potential participants were identified and invited via email to complete an online survey. Only urologists practising in an EU country were eligible to participate. Statistical analyses were carried out using SPSS version 18.0. The χ (2) test was used to compare responses between those who do and do not follow an AS protocol.
Response rate was 8% (n = 226). Ninety-seven per cent urologists offer AS; 25% (n = 53/215) within a clinical trial and a further 28% (n = 60/215) using an official AS protocol. Gleason score ≤ 3 + 3 = 6 (87 %, n = 173/200) and prostate-specific antigen (PSA) ≤ 10 ng/ml (86%, n = 170/198) are the commonest selection criteria. There was a statistically significant association between having an AS protocol and using PSA as an eligibility criterion (p = 0.03). For urologists not following a protocol, 11% do not consider PSA as an eligibility criterion and 81% consider PSA ≤ 10 ng/ml to decide on AS, compared to 2 and 90%, respectively, who adhere to a protocol. Twenty-four per cent of urologists without a protocol do not re-biopsy in comparison to 11% with a protocol (p = 0.026). Gleason score progression trigger the most intervention (n = 168/192, 87%).
Urologists not adhering to an AS protocol or participating in a clinical trial appear to apply less rigorous criteria for both eligibility and monitoring in AS.
主动监测（AS）是低风险前列腺癌（PCa）公认的治疗选择。
从患者选择、随访及干预指征方面回顾主动监测标准。
共识别出2959名潜在参与者，并通过电子邮件邀请他们完成一项在线调查。只有在欧盟国家执业的泌尿科医生才有资格参与。使用SPSS 18.0版进行统计分析。采用χ²检验比较遵循和不遵循主动监测方案者的回答。
回复率为8%（n = 226）。97%的泌尿科医生提供主动监测；其中25%（n = 53/215）在临床试验中进行，另有28%（n = 60/215）使用官方主动监测方案。Gleason评分≤3 + 3 = 6（87%，n = 173/200）和前列腺特异性抗原（PSA）≤10 ng/ml（86%，n = 170/198）是最常见的选择标准。拥有主动监测方案与将PSA作为入选标准之间存在统计学显著关联（p = 0.03）。对于不遵循方案的泌尿科医生，11%不将PSA作为入选标准，81%认为PSA≤10 ng/ml来决定是否进行主动监测，相比之下，遵循方案者分别为2%和90%。24%没有方案的泌尿科医生不进行再次活检，而有方案者为11%（p = 0.026）。Gleason评分进展引发的干预最多（n = 168/192，87%）。
不遵循主动监测方案或不参与临床试验的泌尿科医生在主动监测的入选和监测标准方面似乎应用得不够严格。
