Celma Domènech Ana, Planas Morin Jacques, Morote Robles Juan
Servicio de Urología. Hospital Vall d'Hebró. Barcelona. España.
Arch Esp Urol. 2014 Jun;67(5):442-51.
Prostate cancer is a highly prevalent disease but with reduced cause-specific mortality. Active surveillance represents an alternative to postpone or avoid the potential sequelae derived from curative treatments in selected patients. The objective of this article is to review the diagnostic and follow-up methods for patients included in active surveillance programs.
We performed an exhaustive bibliographic review with the terms "Prostate cancer", "Active surveillance", "expectant management", including the greatest series published since 2007.
Awaiting for genetic markers that help us to predict diagnosis and evolution of prostate cancer, PSA kinetics, digital rectal examination and repeated biopsies continue being the inclusion and follow up criteria for patients in active surveillance programs. Emerging complementary tests such as multi parametric MRI, PCA3 and Phi seem to add specificity to the existing clinical criteria. The reduced number of patients included, the limited follow up and the great disparity of inclusion and follow up criteria between different groups make the implementation of consensus guidelines that could help a more widespread application of this alternative difficult.
前列腺癌是一种高度常见的疾病，但特定病因死亡率有所降低。主动监测是一种替代方案，可在特定患者中推迟或避免根治性治疗带来的潜在后遗症。本文的目的是回顾纳入主动监测项目患者的诊断和随访方法。
我们使用“前列腺癌”“主动监测”“期待管理”等术语进行了详尽的文献综述，包括自2007年以来发表的最大系列研究。
在等待有助于预测前列腺癌诊断和进展的基因标志物期间，前列腺特异性抗原（PSA）动力学、直肠指检和重复活检仍是主动监测项目患者的纳入和随访标准。多参数MRI、PCA3和Phi等新兴补充检查似乎能提高现有临床标准的特异性。纳入患者数量减少、随访有限以及不同组之间纳入和随访标准差异巨大，使得实施有助于更广泛应用这种替代方案的共识指南变得困难。
