Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; D. Andrew Loblaw, Sunnybrook Health Sciences Centre; Antonio Finelli, Princess Margaret Hospital, Toronto; Scott C. Morgan, University of Ottawa, Ottawa, Ontario; Scott Tyldesley, The British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada; Behfar Ehdaie, Memorial Sloan Kettering Cancer Center, New York, NY; Matthew R. Cooperberg, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; John J. Haluschak, Dayton Physicians Network, Dayton, OH; Winston Tan, Mayo Clinic Florida, Jacksonville, FL; Stewart Justman, University of Montana, Missoula, MT; and Suneil Jain, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
J Clin Oncol. 2016 Jun 20;34(18):2182-90. doi: 10.1200/JCO.2015.65.7759. Epub 2016 Feb 16.
To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.
The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations.
The ASCO Endorsement Panel determined that the recommendations from the Active Surveillance for the Management of Localized Prostate Cancer guideline, published in May 2015, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Active Surveillance for the Management of Localized Prostate Cancer guideline with added qualifying statements. The Cancer Care Ontario recommendation regarding 5-alpha reductase inhibitors was not endorsed by the ASCO panel.
For most patients with low-risk (Gleason score ≤ 6) localized prostate cancer, active surveillance is the recommended disease management strategy. Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions. Select patients with low-volume, intermediate-risk (Gleason 3 + 4 = 7) prostate cancer may be offered active surveillance. Active surveillance protocols should include prostate-specific antigen testing, digital rectal examinations, and serial prostate biopsies. Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings. Patients who are reclassified to a higher-risk category (Gleason score ≥ 7) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy.
支持安大略癌症护理学会（Cancer Care Ontario）发布的《前列腺癌局部主动监测管理指南》。美国临床肿瘤学会（American Society of Clinical Oncology，ASCO）有一套政策和程序，用于认可其他专业组织制定的临床实践指南。
对《前列腺癌局部主动监测管理指南》进行方法学方面的严格审查。随后，ASCO 认可小组对指南内容和推荐意见进行了审查。
ASCO 认可小组认为，2015 年 5 月发布的《前列腺癌局部主动监测管理指南》中的推荐意见明确、全面，并且基于最相关的科学证据。ASCO 认可了《前列腺癌局部主动监测管理指南》，但增加了限定性说明。然而，ASCO 小组并未认可安大略癌症护理学会关于 5-α 还原酶抑制剂的推荐意见。
对于大多数低危（Gleason 评分≤6）局限性前列腺癌患者，主动监测是推荐的疾病管理策略。在做出管理决策时，应考虑年龄较小、前列腺癌体积、患者偏好和种族等因素。对于低体积、中危（Gleason 评分 3+4=7）局限性前列腺癌患者，可以考虑进行主动监测。主动监测方案应包括前列腺特异性抗原检测、直肠指检和连续前列腺活检。辅助影像学和基因组检测仍处于研究阶段，但在具有不一致的临床和/或病理发现的患者中可能具有一定作用。对于重新分类为高危（Gleason 评分≥7）或后续活检中肿瘤体积明显增加的患者，应提供主动治疗。
