Thostrup Mathias, Thomsen Frederik B, Iversen Peter, Brasso Klaus
a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
Scand J Urol. 2018 Feb;52(1):14-19. doi: 10.1080/21681805.2017.1380697. Epub 2017 Sep 28.
The purpose of active surveillance (AS) is to reduce overtreatment of men with localized prostate cancer (PCa) without compromising survival. The objective of this study was to update a large Scandinavian single-center AS cohort. Furthermore, the use of curative treatment and subsequent risk of biochemical recurrence were investigated and compared in men with very low-risk, low-risk and intermediate-risk PCa in the cohort.
In total, 451 men were followed on AS and monitored with prostate-specific antigen (PSA) tests, digital rectal examinations and rebiopsies. Recommendation of curative treatment was based on protocolled and predefined risk of progression criteria. Biochemical recurrence was defined as PSA ≥0.2 ng/ml after radical prostatectomy and PSA nadir +2 ng/ml after radiotherapy.
Altogether, 34% were defined with very low-risk PCa, 40% with low-risk PCa and 24% with intermediate-risk PCa. The median follow-up was 5.1 years. The estimated 5 year curatively intended treatment-free survival was 60.5% [95% confidence interval (CI) 54.8-66.2%], with no statistically significant difference between men with very low-risk, low-risk or intermediate-risk PCa. The 5 year biochemical recurrence-free survival was 92.3% (95% CI 87.4-97.2), again with no difference between men with very low-risk, low-risk and intermediate-risk PCa.
AS for very low- to low-risk localized PCa is feasible and safe within the short to intermediate time frame. Men with intermediate-risk PCa had the same risk of undergoing curative treatment as men with low-risk PCa, without compromising biochemical recurrence-free survival.
主动监测（AS）的目的是减少局限性前列腺癌（PCa）男性的过度治疗，同时不影响生存率。本研究的目的是更新一个大型的斯堪的纳维亚单中心AS队列。此外，还对该队列中极低风险、低风险和中风险PCa男性的根治性治疗使用情况及随后的生化复发风险进行了调查和比较。
共有451名男性接受AS随访，并通过前列腺特异性抗原（PSA）检测、直肠指检和重复活检进行监测。根治性治疗的推荐基于方案规定和预先定义的疾病进展风险标准。生化复发定义为根治性前列腺切除术后PSA≥0.2 ng/ml，放疗后PSA最低点+2 ng/ml。
总体而言，34%被定义为极低风险PCa，40%为低风险PCa，24%为中风险PCa。中位随访时间为5.1年。估计5年无根治性治疗的生存率为60.5%[95%置信区间（CI）54.8 - 66.2%]，极低风险、低风险或中风险PCa男性之间无统计学显著差异。5年无生化复发生存率为92.3%（95%CI 87.4 - 97.2），极低风险、低风险和中风险PCa男性之间同样无差异。
对于极低至低风险的局限性PCa，在短期至中期时间范围内，AS是可行且安全的。中风险PCa男性接受根治性治疗的风险与低风险PCa男性相同，且不影响无生化复发生存率。
