Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
J Urol. 2018 Feb;199(2):445-452. doi: 10.1016/j.juro.2017.08.006. Epub 2017 Aug 5.
We determined the effect of 5α-reductase inhibitors on disease reclassification in men with prostate cancer optimally selected for active surveillance.
In this retrospective review we identified 635 patients on active surveillance between 2002 and 2015. Patients with favorable cancer features on repeat biopsy, defined as absent Gleason upgrading, were included in the cohort. Patients were stratified by those who did or did not receive finasteride or dutasteride within 1 year of diagnosis. The primary end point was grade reclassification, defined as any increase in Gleason score or predominant Gleason pattern on subsequent biopsy. This was assessed by multivariable Cox proportional hazards regression analysis.
At diagnosis 371 patients met study inclusion criteria, of whom 70 (19%) were started on 5α-reductase inhibitors within 12 months. Median time on active surveillance was 53 vs 35 months in men on vs not on 5α-reductase inhibitors (p <0.01). Men on 5α-reductase inhibitors received them for a median of 23 months (IQR 6-37). On actuarial analysis there was no significant difference in grade reclassification for 5α-reductase inhibitor use in patients overall or in the very low/low risk subset. The overall percent of patients who experienced grade reclassification was similar at 13% vs 14% (p = 0.75). After adjusting for baseline clinicopathological features 5α-reductase inhibitors were not significantly associated with grade reclassification (HR 0.80, 95% CI 0.31-1.80, p = 0.62). Furthermore, no difference in adverse features on radical prostatectomy specimens was observed in treated patients (p = 0.36).
Among our cohort of men on active surveillance 5α-reductase inhibitor use was not associated with a significant difference in grade reclassification with time.
我们旨在确定 5α-还原酶抑制剂对经过最佳选择进行主动监测的前列腺癌患者疾病再分类的影响。
在这项回顾性研究中，我们于 2002 年至 2015 年期间确定了 635 名接受主动监测的患者。在重复活检中具有有利癌症特征的患者（定义为无 Gleason 升级）被纳入该队列。根据患者在诊断后 1 年内是否接受非那雄胺或度他雄胺进行分层。主要终点是分级再分类，定义为后续活检中任何 Gleason 评分增加或主要 Gleason 模式改变。通过多变量 Cox 比例风险回归分析进行评估。
在诊断时，371 名患者符合研究纳入标准，其中 70 名（19%）在 12 个月内开始使用 5α-还原酶抑制剂。接受 5α-还原酶抑制剂的患者中位主动监测时间为 53 个月，而未接受 5α-还原酶抑制剂的患者为 35 个月（p<0.01）。接受 5α-还原酶抑制剂的患者中位使用时间为 23 个月（IQR 6-37）。在实际分析中，5α-还原酶抑制剂的使用在总体患者或极低/低风险亚组中，在分级再分类方面没有显著差异。在 13%和 14%的患者中经历分级再分类的比例相似（p=0.75）。调整基线临床病理特征后，5α-还原酶抑制剂与分级再分类无显著相关性（HR 0.80，95%CI 0.31-1.80，p=0.62）。此外，在接受治疗的患者中，在根治性前列腺切除标本中未观察到不良特征的差异（p=0.36）。
在我们的主动监测队列中，5α-还原酶抑制剂的使用与随时间的分级再分类无显著差异。
