School of Social and Community Medicine, University of Bristol, Bristol, UK.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Eur Urol. 2015 Jun;67(6):993-1005. doi: 10.1016/j.eururo.2015.01.004. Epub 2015 Jan 21.
Many men with clinically localized prostate cancer are being monitored as part of active surveillance (AS) programs, but little is known about reasons for receiving radical treatment.
A systematic review of the evidence about AS was undertaken, with a meta-analysis to identify predictors of radical treatment.
A comprehensive search of the Embase, MEDLINE and Web of Knowledge databases to March 2014 was performed. Studies reporting on men with localized prostate cancer followed by AS or monitoring were included. AS was defined where objective eligibility criteria, management strategies, and triggers for clinical review or radical treatment were reported.
The 26 AS cohorts included 7627 men, with a median follow-up of 3.5 yr (range of medians 1.5-7.5 yr). The cohorts had a wide range of inclusion criteria, monitoring protocols, and triggers for radical treatment. There were eight prostate cancer deaths and five cases of metastases in 24,981 person-years of follow-up. Each year, 8.8% of men (95% confidence interval 6.7-11.0%) received radical treatment, most commonly because of biopsy findings, prostate-specific antigen triggers, or patient choice driven by anxiety. Studies in which most men changed treatment were those including only low-risk Gleason score 6 disease and scheduled rebiopsies.
The wide variety of AS protocols and lack of robust evidence make firm conclusions difficult. Currently, patients and clinicians have to make judgments about the balance of risks and benefits in AS protocols. The publication of robust evidence from randomized trials and longer-term follow-up of cohorts is urgently required.
We reviewed 26 studies of men on active surveillance for prostate cancer. There was evidence that studies including men with the lowest risk disease and scheduled rebiopsy had higher rates of radical treatment.
许多患有局限性前列腺癌的男性正在接受主动监测（AS）计划的监测，但对于接受根治性治疗的原因知之甚少。
对 AS 的证据进行系统回顾，并进行荟萃分析以确定根治性治疗的预测因素。
对 Embase、MEDLINE 和 Web of Knowledge 数据库进行全面检索，检索时间截至 2014 年 3 月。纳入了报告接受局限性前列腺癌治疗后接受 AS 或监测的男性的研究。AS 的定义是报告了客观的纳入标准、管理策略和临床复查或根治性治疗的触发因素。
26 项 AS 队列纳入了 7627 名男性，中位随访时间为 3.5 年（中位数范围为 1.5-7.5 年）。这些队列的纳入标准、监测方案和根治性治疗的触发因素差异很大。在 24981 人年的随访中，有 8 例前列腺癌死亡和 5 例转移病例。每年有 8.8%（95%置信区间为 6.7-11.0%）的男性接受根治性治疗，最常见的原因是活检结果、前列腺特异性抗原触发因素或因焦虑而选择的患者意愿。大多数男性改变治疗方案的研究是那些仅包括低风险 Gleason 评分 6 疾病和计划进行再次活检的研究。
由于 AS 方案的多样性和缺乏可靠证据，难以得出明确的结论。目前，患者和临床医生必须在 AS 方案中对风险和获益进行权衡。迫切需要发表来自随机试验的可靠证据和对队列进行更长时间的随访。
我们回顾了 26 项关于前列腺癌主动监测的男性研究。有证据表明，包括最低风险疾病和计划再次活检的研究，根治性治疗的比例更高。
