Jiang Song, Narayan Vikram, Warlick Christopher
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
Transl Androl Urol. 2018 Apr;7(2):214-220. doi: 10.21037/tau.2017.09.11.
Active surveillance (AS) for the management of low-risk prostate cancer has been increasing and in the general population appears safe, allowing for a reduction in the harms of prostate cancer screening such as overtreatment. African-American (AA) men have overall worse outcomes from prostate cancer compared to Caucasian-American (CA) men for a variety of socioeconomic, cultural and possibly biologic reasons, thus complicating the use of AS in this population. Strategies for optimizing care and mitigating risk in this population include pursuing close surveillance with steadfast patient compliance, the use of multiparametric MRI with targeted biopsies including the anterior prostate to reduce the risk of undersampling, as well as a judicious and thoughtful incorporation of novel molecular biomarkers for risk stratification. Currently, there exists no direct data to suggest that AS cannot be safely carried out in AA men following an informed discussion and after engaging in shared decision making. Physicians should have a low threshold for consideration of definitive therapy. Additional efforts should be made in increasing the engagement of minority participants in clinical trials, to gain an improved representation of underserved populations in future research.
对低风险前列腺癌进行主动监测（AS）的应用一直在增加，在普通人群中似乎是安全的，这有助于减少前列腺癌筛查带来的危害，如过度治疗。由于各种社会经济、文化以及可能的生物学原因，与美国白人（CA）男性相比，非裔美国（AA）男性前列腺癌的总体预后更差，这使得在该人群中应用AS变得复杂。在该人群中优化护理和降低风险的策略包括：在患者坚定依从的情况下进行密切监测；使用多参数MRI并结合靶向活检，包括对前列腺前部进行活检，以降低取样不足的风险；以及明智且审慎地纳入新型分子生物标志物进行风险分层。目前，没有直接数据表明在经过充分讨论并参与共同决策后，AA男性不能安全地进行AS。医生应降低对确定性治疗的考虑门槛。应做出更多努力，增加少数族裔参与者参与临床试验的机会，以便在未来研究中更好地代表服务不足的人群。
