Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France.
Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France.
J Urol. 2017 May;197(5):1229-1236. doi: 10.1016/j.juro.2016.12.047. Epub 2016 Dec 18.
Active surveillance is a treatment option for favorable risk prostate cancer. However, data are missing on populations of African descent. We evaluated the safety and benefit of active surveillance in an African Caribbean cohort with favorable risk prostate cancer.
Between 2005 and 2016, a single center, prospective cohort study was performed in Guadeloupe, French West Indies, including patients on active surveillance who had low risk prostate cancer (prostate specific antigen 10 ng/ml or less and Gleason score 6 or less) or favorable intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, Gleason score 3 + 4 or less and life expectancy less than 10 years). Treatment was recommended in case of grade progression, increased tumor volume, prostate cancer doubling time less than 36 months or patient wish. Overall survival, disease specific survival and duration of active surveillance were calculated with the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards model to identify predictors of active surveillance termination.
A total of 234 patients with a median age of 64 years were enrolled in study. Median followup was 4 years (IQR 2.3-5.5). Overall survival at 30 months, 5 years and 10 years was 99.5%, 98.5% and 90.7%, respectively. Disease specific survival at 30 months, and 5 and 10 years was 100%. At 30 months, 5 years and 10 years 72.7%, 52.6% and 40.4% of patients, respectively, remained untreated and on active surveillance. Age (HR 0.96 per additional year, 95% CI 0.93-0.99) and prostate specific antigen density (HR 1.52 per additional 0.1 ng/ml, 95% CI 1.20-1.89) were found to be independent predictors of active surveillance termination.
Active surveillance is safe and beneficial for highly selected African Caribbean patients. It seems to be feasible for patients at low risk and intermediate favorable risk. Prostate specific antigen density could help better select these patients.
主动监测是低危前列腺癌的一种治疗选择。然而，非洲裔人群的数据尚不清楚。我们评估了在法属安的列斯群岛瓜德罗普的一个非洲加勒比队列中，具有低危前列腺癌（前列腺特异性抗原 10ng/ml 或更低和 Gleason 评分 6 或更低）或中危前列腺癌（前列腺特异性抗原 10 至 20ng/ml，Gleason 评分 3+4 或更低和预期寿命少于 10 年）的高危前列腺癌患者中主动监测的安全性和益处。如果出现分级进展、肿瘤体积增大、前列腺癌倍增时间小于 36 个月或患者意愿，建议进行治疗。使用 Kaplan-Meier 方法计算总生存率、疾病特异性生存率和主动监测持续时间。使用 Cox 比例风险模型进行多变量分析，以确定主动监测终止的预测因素。
共纳入 234 例中位年龄为 64 岁的患者。中位随访时间为 4 年（IQR 2.3-5.5）。30 个月、5 年和 10 年的总生存率分别为 99.5%、98.5%和 90.7%。30 个月、5 年和 10 年的疾病特异性生存率均为 100%。30 个月、5 年和 10 年分别有 72.7%、52.6%和 40.4%的患者未接受治疗并继续接受主动监测。年龄（每增加 1 年风险比为 0.96，95%CI 0.93-0.99）和前列腺特异性抗原密度（每增加 0.1ng/ml 风险比为 1.52，95%CI 1.20-1.89）是主动监测终止的独立预测因素。
主动监测对高度选择的非洲加勒比患者是安全且有益的。对于低危和中危患者似乎是可行的。前列腺特异性抗原密度可能有助于更好地选择这些患者。
