Ingimarsson Johann P, Celaya Maria O, Laviolette Michael, Rees Judy R, Hyams Elias S
Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,
Cancer Causes Control. 2015 Jun;26(6):923-9. doi: 10.1007/s10552-015-0574-8. Epub 2015 Apr 4.
Prostate cancer management strategies are evolving with increased understanding of the disease. Specifically, there is emerging evidence that "low-risk" cancer is best treated with observation, while localized "high-risk" cancer requires aggressive curative therapy. In this study, we evaluated trends in management of prostate cancer in New Hampshire to determine adherence to evidence-based practice.
From the New Hampshire State Cancer Registry, cases of clinically localized prostate cancer diagnosed in 2004-2011 were identified and classified according to D'Amico criteria. Initial treatment modality was recorded as surgery, radiation therapy, expectant management, or hormone therapy. Temporal trends were assessed by Chi-square for trend.
Of 6,203 clinically localized prostate cancers meeting inclusion criteria, 34, 30, and 28% were low-, intermediate-, and high-risk disease, respectively. For low-risk disease, use of expectant management (17-42%, p < 0.001) and surgery (29-39%, p < 0.001) increased, while use of radiation therapy decreased (49-19 %, p < 0.001). For intermediate-risk disease, use of surgery increased (24-50%, p < 0.001), while radiation decreased (58-34%, p < 0.001). Hormonal therapy alone was rarely used for low- and intermediate-risk disease. For high-risk patients, surgery increased (38-47%, p = 0.003) and radiation decreased (41-38%, p = 0.026), while hormonal therapy and expectant management remained stable.
There are encouraging trends in the management of clinically localized prostate cancer in New Hampshire, including less aggressive treatment of low-risk cancer and increasing surgical treatment of high-risk disease.
随着对前列腺癌认识的加深，其管理策略也在不断演变。具体而言，越来越多的证据表明，“低风险”癌症最好采用观察等待的方式进行治疗，而局限性“高风险”癌症则需要积极的根治性治疗。在本研究中，我们评估了新罕布什尔州前列腺癌的管理趋势，以确定是否遵循循证医学实践。
从新罕布什尔州癌症登记处识别出2004年至2011年诊断为临床局限性前列腺癌的病例，并根据达米科标准进行分类。初始治疗方式记录为手术、放射治疗、观察等待或激素治疗。采用卡方检验趋势评估时间趋势。
在符合纳入标准的6203例临床局限性前列腺癌中，低风险、中风险和高风险疾病分别占34%、30%和28%。对于低风险疾病，观察等待（17% - 42%，p < 0.001）和手术（29% - 39%，p < 0.001）的使用增加，而放射治疗的使用减少（49% - 19%，p < 0.001）。对于中风险疾病，手术的使用增加（24% - 50%，p < 0.001），而放射治疗减少（58% - 34%，p < 0.001）。单独的激素治疗很少用于低风险和中风险疾病。对于高风险患者，手术增加（38% - 47%，p = 0.003），放射治疗减少（41% - 38%，p = 0.026），而激素治疗和观察等待保持稳定。
新罕布什尔州临床局限性前列腺癌的管理出现了令人鼓舞的趋势，包括对低风险癌症采取不那么激进的治疗，以及对高风险疾病增加手术治疗。
