Goldberg Hanan, Klaassen Zachary, Chandrasekar Thenappan, Fleshner Neil
Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
Curr Opin Urol. 2018 Jan;28(1):46-54. doi: 10.1097/MOU.0000000000000455.
Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression.
Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5α-reductase inhibitors and others might inhibit disease progression in patients on active surveillance.
Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.
主动监测是局限性、低风险前列腺癌（CaP）男性患者已确立的治疗选择。它需要推迟立即治疗，并在疾病进展时选择延迟干预。在15年的时间里，主动监测的临床进展率和治疗需求约为50%。本综述总结了有关当前方法的最新数据，试图预防临床进展。
为主动监测选择患者是降低进展所需的首要必要步骤。遵守主动监测方案对于确保患者得到良好监测并在进展发生时尽早治疗至关重要。在分配主动监测之前以及主动监测随访期间，涉及多参数MRI、前列腺特异性抗原衍生物、活检因素、尿液、组织和基因标志物的方法可用于预防临床进展和/或识别有进展风险的患者。5α还原酶抑制剂等药物可能会抑制接受主动监测患者的疾病进展。
由于过度诊断以及我们无法准确预测个体CaP行为，因此需要进行主动监测。几种方法可能会降低接受主动监测患者CaP进展的风险。然而，主动监测的患者及其治疗医生总会伴随着一定程度的不确定性和对进展的恐惧。
