Newcomb Lisa F, Thompson Ian M, Boyer Hilary D, Brooks James D, Carroll Peter R, Cooperberg Matthew R, Dash Atreya, Ellis William J, Fazli Ladan, Feng Ziding, Gleave Martin E, Kunju Priya, Lance Raymond S, McKenney Jesse K, Meng Maxwell V, Nicolas Marlo M, Sanda Martin G, Simko Jeffry, So Alan, Tretiakova Maria S, Troyer Dean A, True Lawrence D, Vakar-Lopez Funda, Virgin Jeff, Wagner Andrew A, Wei John T, Zheng Yingye, Nelson Peter S, Lin Daniel W
Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington.
University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
J Urol. 2016 Feb;195(2):313-20. doi: 10.1016/j.juro.2015.08.087. Epub 2015 Aug 29.
Active surveillance represents a strategy to address the overtreatment of prostate cancer, yet uncertainty regarding individual patient outcomes remains a concern. We evaluated outcomes in a prospective multicenter study of active surveillance.
We studied 905 men in the prospective Canary PASS enrolled between 2008 and 2013. We collected clinical data at study entry and at prespecified intervals, and determined associations with adverse reclassification, defined as increased Gleason grade or greater cancer volume on followup biopsy. We also evaluated the relationships of clinical parameters with pathology findings in participants who underwent surgery after a period of active surveillance.
At a median followup of 28 months 24% of participants experienced adverse reclassification, of whom 53% underwent treatment while 31% continued on active surveillance. Overall 19% of participants received treatment, 68% with adverse reclassification, while 32% opted for treatment without disease reclassification. In multivariate Cox proportional hazards modeling the percent of biopsy cores with cancer, body mass index and prostate specific antigen density were associated with adverse reclassification (p=0.01, 0.04, 0.04, respectively). Of 103 participants subsequently treated with radical prostatectomy 34% had adverse pathology, defined as primary pattern 4-5 or nonorgan confined disease, including 2 with positive lymph nodes, with no significant relationship between risk category at diagnosis and findings at surgery (p=0.76).
Most men remain on active surveillance at 5 years without adverse reclassification or adverse pathology at surgery. However, clinical factors had only a modest association with disease reclassification, supporting the need for approaches that improve the prediction of this outcome.
主动监测是一种应对前列腺癌过度治疗的策略，但个体患者预后的不确定性仍是一个问题。我们在一项主动监测的前瞻性多中心研究中评估了预后情况。
我们研究了2008年至2013年间纳入前瞻性加那利群岛前列腺癌主动监测研究（Canary PASS）的905名男性。我们在研究开始时和预定间隔收集临床数据，并确定与不良重新分类的关联，不良重新分类定义为随访活检时Gleason分级增加或癌体积增大。我们还评估了在一段时间的主动监测后接受手术的参与者的临床参数与病理结果之间的关系。
在中位随访28个月时，24%的参与者经历了不良重新分类，其中53%接受了治疗，31%继续进行主动监测。总体而言，19%的参与者接受了治疗，68%是因为不良重新分类，而32%在没有疾病重新分类的情况下选择了治疗。在多变量Cox比例风险模型中，有癌的活检芯百分比、体重指数和前列腺特异性抗原密度与不良重新分类相关（分别为p = 0.01、0.04、0.04）。在随后接受根治性前列腺切除术的103名参与者中，34%有不良病理结果，定义为主要模式4 - 5或非器官局限性疾病，包括2例淋巴结阳性，诊断时的风险类别与手术结果之间无显著关系（p = 0.76）。
大多数男性在5年时仍处于主动监测状态，没有不良重新分类或手术时的不良病理结果。然而，临床因素与疾病重新分类的关联较小，这支持了需要改进对这一结果预测方法的必要性。
