Department of Urology, Keimyung University School of Medicine, Daegu, Korea.
Investig Clin Urol. 2017 May;58(3):164-170. doi: 10.4111/icu.2017.58.3.164. Epub 2017 Apr 13.
Update and reanalysis of our experience of active surveillance (AS) for prostate cancer (PCa) in Korea.
A prospective, single-arm, cohort study was initiated in January 2008. Patients were selected according to the following criteria: Gleason sum ≤6 with single positive core with ≤30% core involvement, clinical stage≤T1c, prostate-specific antigen (PSA)≤10 ng/mL, and negative magnetic resonance imaging (MRI) results. Follow-up was by PSA measurement every 6 months, prostate biopsies at 1 year and then every 2-3 years, and MRI every year.
A total of 80 patients were treated with AS. Median follow-up was 52 months (range, 6-96 months). Of them, 39 patients (48.8%) discontinued AS for various reasons (17, disease progression; 9, patient preference; 10, watchful waiting due to old age; 3, follow-up loss; 2, death). The probability of progression was 14.0% and 42.9% at 1 and 3 years, respectively. Overall survival was 97.5%. PCa-specific survival was 100%. Progression occurred in 5 of 7 patients (71.4%) with a prostate volume less than 30 mL, 7 of 40 patients (17.5%) with a prostate volume of 30 to 50 mL, and 5 of 33 patients (15.2%) with a prostate volume of 50 mL or larger. There were 8 detectable positive lesions on follow-up MRI. Of them, 6 patients (75%) had actual progressed disease.
Small prostate volume was associated with a tendency for cancer progression. MRI was helpful and promising for managing AS. Nevertheless, regular biopsies should be performed. AS is a safe and feasible treatment option for very-low-risk PCa in Korea. However, AS should continue to be used in carefully selected patients.
更新并重新分析我们在韩国进行前列腺癌（PCa）主动监测（AS）的经验。
2008 年 1 月开始进行一项前瞻性、单臂、队列研究。患者根据以下标准入选：Gleason 总和≤6，单一阳性核心且核心受累≤30%，临床分期≤T1c，前列腺特异性抗原（PSA）≤10ng/ml，且 MRI 结果阴性。随访方式为每 6 个月进行 PSA 检测，1 年后进行前列腺活检，然后每 2-3 年进行一次，每年进行一次 MRI。
共有 80 例患者接受 AS 治疗。中位随访时间为 52 个月（范围 6-96 个月）。其中，39 例（48.8%）因各种原因停止 AS（17 例，疾病进展；9 例，患者偏好；10 例，因年龄较大而观察等待；3 例，随访丢失；2 例，死亡）。1 年和 3 年时的进展概率分别为 14.0%和 42.9%。总体生存率为 97.5%。PCa 特异性生存率为 100%。进展发生在 7 例前列腺体积<30ml 的患者中的 5 例（71.4%）、40 例前列腺体积为 30-50ml 的患者中的 7 例（17.5%）和 33 例前列腺体积≥50ml 的患者中的 5 例（15.2%）。在随访 MRI 上发现了 8 个可检测到的阳性病变。其中，6 例（75%）患者的实际疾病进展。
较小的前列腺体积与癌症进展的趋势相关。MRI 对管理 AS 有帮助且有前景。然而，应定期进行活检。AS 是韩国极低危 PCa 的一种安全且可行的治疗选择。然而，AS 应继续在精心挑选的患者中使用。
