University of Michigan, Ann Arbor, Michigan.
Johns Hopkins University, Baltimore, Maryland.
Cancer. 2018 Feb 15;124(4):698-705. doi: 10.1002/cncr.31101. Epub 2017 Nov 13.
Active surveillance (AS) for prostate cancer includes follow-up with serial prostate biopsies. The optimal biopsy frequency during follow-up has not been determined. The goal of this investigation was to use longitudinal AS biopsy data to assess whether the frequency of biopsy could be reduced without substantially prolonging the time to the detection of disease with a Gleason score ≥ 7.
With data from 1375 men with low-risk prostate cancer enrolled in AS at Johns Hopkins, a hidden Markov model was developed to estimate the probability of undersampling at diagnosis, the annual probability of grade progression, and the 10-year cumulative probability of reclassification or progression to Gleason score ≥ 7. It simulated 1024 potential AS biopsy strategies for the 10 years after diagnosis. For each of these strategies, the model predicted the mean delay in the detection of disease with a Gleason score ≥ 7.
The model estimated the 10-year cumulative probability of reclassification from a Gleason score of 6 to a Gleason score ≥ 7 to be 40.0%. The probability of undersampling at diagnosis was 9.8%, and the annual progression probability for men with a Gleason score of 6 was 4.0%. On the basis of these estimates, a simulation of an annual biopsy strategy estimated the mean time to the detection of disease with a Gleason score ≥ 7 to be 14.1 months; however, several strategies eliminated biopsies with only small delays (<12 months) in detecting grade progression.
Although annual biopsy for low-risk men on AS is associated with the shortest time to the detection of disease with a Gleason score ≥ 7, several alternative strategies may allow less frequent biopsying without sizable delays in detecting grade progression. Cancer 2018;124:698-705. © 2017 American Cancer Society.
前列腺癌的主动监测（AS）包括通过连续前列腺活检进行随访。在随访期间，最佳的活检频率尚未确定。本研究的目的是使用纵向 AS 活检数据来评估是否可以减少活检频率，而不会显著延长发现 Gleason 评分≥7 的疾病的时间。
使用约翰霍普金斯大学 1375 名低危前列腺癌患者的 AS 数据，开发了一个隐马尔可夫模型来估计诊断时抽样不足的概率、每年分级进展的概率以及 10 年内重新分类或进展为 Gleason 评分≥7 的 10 年累积概率。它模拟了诊断后 10 年内 1024 种潜在的 AS 活检策略。对于这些策略中的每一种，该模型预测了 Gleason 评分≥7 的疾病检出延迟的平均时间。
该模型估计 Gleason 评分从 6 分到 Gleason 评分≥7 分的 10 年累积重新分类概率为 40.0%。诊断时抽样不足的概率为 9.8%，Gleason 评分 6 分的男性每年进展的概率为 4.0%。基于这些估计，对每年一次活检策略的模拟估计，发现 Gleason 评分≥7 的疾病检出时间的平均时间为 14.1 个月；然而，一些策略在检测分级进展方面仅延迟较小（<12 个月），从而消除了活检。
尽管 AS 低危男性每年一次的活检与发现 Gleason 评分≥7 的疾病的时间最短，但几种替代策略可能允许较少的活检频率，而不会显著延迟检测分级进展。癌症 2018;124:698-705. © 2017 美国癌症协会。
