Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Eur Urol Focus. 2019 Mar;5(2):171-178. doi: 10.1016/j.euf.2017.07.003. Epub 2017 Aug 8.
Active surveillance (AS) has been increasingly proposed as the preferential initial management strategy for low-risk prostate cancer (PC), while in high-risk PC the indication for surgery has widened.
To evaluate the development of risk group distribution of patients undergoing radical prostatectomy (RP).
DESIGN, SETTING, AND PARTICIPANTS: Retrospective database review of combined RP databases (2000-2015) of four large European centers (Créteil, Paris; San Rafaele, Milan; Martini Klinik, Hamburg; NKI, AvL, Amsterdam).
Clinical and pathological characteristics per year of surgery. Eligibility for AS was defined according to Prostate Cancer Research International Active Surveillance criteria: cT≤2c, cN0/X, cM0/X, PSA ≤10ng/ml, prostate-specific antigen density <0.2ng/ml/ml, one to two positive biopsies, and Gleason score ≤6, high-risk disease as: cT≥3, c N1, cM1, PSA >20ng/ml, and/or Gleason ≥8.
In total, 28572 patients had complete clinical and 24790 complete pathological data available. The absolute number of RPs increased: 401, 975, 2344, and 2504 in 2000, 2005, 2010, and 2015, respectively. The proportion of cases considered suitable for AS decreased: 31%, 32%, 18%, and 5%, while the cases considered high risk increased: 10%, 8%, 16%, and 30%. The percentage of patients having only localized Gleason 6 disease after RP decreased: 46%, 34%, 14%, and 8% for all patients (p<0.01), as well as for AS-suitable patients: 70%, 54%, 41%, and 38% (p<0.01). Comparisons between centers were outside the scope of this article. Developments in diagnostics may have impacted on results.
This European analysis confirmed the risk profile of patients undergoing RP shifting away of the most favorable disease spectrum. Patients with PC clinically considered suitable for AS and men having only localized Gleason 6 disease pathologically comprised a decreasing share of all RP performed. High-risk disease comprised an increasing share of all RPs.
The databases of four large European centers of prostate cancer surgery were analyzed. In recent years, the risk profile of patients shifted away of low-risk cancer, while high-risk cancer comprised a larger part of cases. This confirms the introduction of active surveillance for low-risk prostate cancer and increase in potentially curative options for high-risk disease.
主动监测（AS）已被越来越多地提出作为低危前列腺癌（PC）的首选初始管理策略，而高危 PC 的手术适应证已经扩大。
评估接受根治性前列腺切除术（RP）的患者的风险组分布的发展情况。
设计、地点和参与者：对四个大型欧洲中心（克里泰尔、巴黎；圣拉斐尔、米兰；马丁尼诊所、汉堡；NKIAVL，阿姆斯特丹）的联合 RP 数据库（2000-2015 年）进行回顾性数据库审查。
每年手术的临床和病理特征。根据前列腺癌研究国际主动监测标准定义 AS 的资格：cT≤2c、cN0/X、cM0/X、PSA≤10ng/ml、前列腺特异性抗原密度<0.2ng/ml/ml、一次至两次活检阳性和 Gleason 评分≤6，高危疾病为：cT≥3、cN1、cM1、PSA>20ng/ml 和/或 Gleason≥8。
共有 28572 例患者有完整的临床资料和 24790 例完整的病理数据。RP 的绝对数量增加：2000 年为 401 例，2005 年为 975 例，2010 年为 2344 例，2015 年为 2504 例。被认为适合 AS 的病例比例下降：31%、32%、18%和 5%，而被认为是高危的病例比例增加：10%、8%、16%和 30%。接受 RP 后仅为局部 Gleason 6 疾病的患者比例下降：所有患者为 46%、34%、14%和 8%（p<0.01），以及适合 AS 的患者为 70%、54%、41%和 38%（p<0.01）。各中心之间的比较不在本文范围内。诊断的发展可能对结果产生影响。
这项欧洲分析证实，接受 RP 的患者的风险状况正在从最有利的疾病谱转移。临床上被认为适合 AS 的 PC 患者和病理上仅有局部 Gleason 6 疾病的患者在所有接受 RP 的患者中所占比例逐渐减少。高危疾病在所有 RP 中所占比例增加。
分析了四个大型欧洲前列腺癌手术中心的数据库。近年来，患者的风险状况已经远离低危癌症，而高危癌症在病例中所占比例更大。这证实了低危前列腺癌的主动监测的引入以及高危疾病的潜在治愈选择的增加。
