Matthew Andrews J, Ashfield James E, Morse Michael, Whelan Thomas F
Department of Urology, Dalhousie University, Halifax, NS;
Department of Urology, Dalhousie University, Saint John, NB.
Can Urol Assoc J. 2014 Nov;8(11-12):E768-74. doi: 10.5489/cuaj.2186.
We assessed oncological outcomes of active surveillance (AS) using a community database and identified factors associated with disease reclassification on surveillance biopsy.
A retrospective review was performed on 200 men on AS. Prostate-specific antigen (PSA) was measured every 3 to 6 months. Prostate biopsies were performed every 1 to 4 years, and at the individual physician's discretion. Disease reclassification was defined as clinical T1 to cT2 progression, or histologically as >2 cores positive, Gleason score >6, or >50% core involvement on surveillance biopsy. Multivariate Cox regression analysis evaluated factors associated with disease reclassification. Kaplan-Meier survival curves were plotted.
We assessed a heterogeneous cohort of 86 patients, with a median age 67.2 years, who received ≥1 surveillance biopsies. The median follow-up was 5.2 years. The median times to first and second surveillance biopsies were 730 and 763 days, respectively. Overall, 47% of patients were reclassified on surveillance biopsy after a median 2.1 years. Factors associated with disease reclassification were PSA density >0.20 (p < 0.0001, hazard ratio [HR] 4.55, 95% confidence interval [CI] 2.116-9.782) and ≥3 positive cores (p = 0.0152, HR 3.956, 95% CI 1.304-12.003) at diagnosis, and number of positive cores on surveillance biopsy. In total, 25 (29%) patients received delayed intervention, with a median time to intervention of 2.6 years. The median time on AS was 4.4 years, with an overall survival of 95% and prostate-specific survival of 100%.
Our community study supports AS to reduce over-treatment of prostate cancer. PSA density >0.20 and ≥3 cores positive are associated with disease reclassification on surveillance biopsy.
我们使用社区数据库评估了主动监测（AS）的肿瘤学结果，并确定了监测活检时疾病重新分类的相关因素。
对200名接受主动监测的男性进行了回顾性研究。每3至6个月测量一次前列腺特异性抗原（PSA）。每1至4年进行一次前列腺活检，具体时间由医生自行决定。疾病重新分类定义为临床T1至cT2进展，或组织学上为监测活检时>2个核心阳性、Gleason评分>6或核心受累>50%。多变量Cox回归分析评估了与疾病重新分类相关的因素。绘制了Kaplan-Meier生存曲线。
我们评估了86名患者的异质性队列，中位年龄为67.2岁，这些患者接受了≥1次监测活检。中位随访时间为5.2年。首次和第二次监测活检的中位时间分别为730天和763天。总体而言，47%的患者在中位2.1年后监测活检时被重新分类。与疾病重新分类相关的因素包括诊断时PSA密度>0.20（p<0.0001，风险比[HR]4.55，95%置信区间[CI]2.116-9.782）和≥3个阳性核心（p=0.0152，HR 3.956，95%CI 1.304-12.003），以及监测活检时的阳性核心数量。共有25名（29%）患者接受了延迟干预，干预的中位时间为2.6年。主动监测的中位时间为4.4年，总生存率为95%，前列腺特异性生存率为100%。
我们的社区研究支持主动监测以减少前列腺癌的过度治疗。PSA密度>0.20和≥3个核心阳性与监测活检时的疾病重新分类相关。
