Monash University, Melbourne, VIC
Monash University, Melbourne, VIC.
Med J Aust. 2018 Jun 4;208(10):439-443. doi: 10.5694/mja17.00559. Epub 2018 May 28.
To characterise the practice of active surveillance (AS) for men with low risk prostate cancer by examining the characteristics of those who commence AS, the rate of adherence to accepted AS follow-up protocols over 2 years, and factors associated with good adherence. Design, setting: Retrospective cohort study; analysis of data collected from 38 sites participating in the Prostate Cancer Outcomes Registry-Victoria.
Men diagnosed with prostate cancer between August 2008 and December 2014 aged 75 years or less at diagnosis, managed by AS for at least 2 years, and with an ISUP grade group of 3 or less (Gleason score no worse than 4 + 3 = 7).
Adherence to an AS schedule consisting of at least three PSA measurements and at least one biopsy in the 2 years following diagnosis.
Of 1635 men eligible for inclusion in the analysis, 433 (26.5%) adhered to the AS protocol. The significant predictor of adherence in the multivariate model was being diagnosed in a private hospital (v public hospital: adjusted odds ratio [aOR], 1.83; 95% CI, 1.42-2.37; P < 0.001). Significant predictors of non-adherence included being diagnosed by transurethral resection of the prostate (v transrectal ultrasound biopsy [TRUS]: OR, 0.54; 95% CI, 0.39-0.77; P < 0.001) or transperineal biopsy (v TRUS: OR, 0.32; 95% CI, 0.19-0.52; P < 0.001), and being 66 years of age or more at diagnosis (v < 55 years: OR, 0.65; 95% CI, 0.45-0.92; P = 0.015).
Almost three-quarters of men who had prostate cancer with low risk of disease progression did not have follow-up investigations consistent with standard AS protocols. The clinical consequences of this shortcoming are unknown.
通过考察开始主动监测 (AS) 的患者特征、两年内接受 AS 随访方案的依从率以及与良好依从性相关的因素，来描述低危前列腺癌患者的 AS 实践。设计、设置：回顾性队列研究；对参与前列腺癌结局注册维多利亚州（Prostate Cancer Outcomes Registry-Victoria）的 38 个站点收集的数据进行分析。参与者：2008 年 8 月至 2014 年 12 月期间诊断为年龄 75 岁或以下的低危前列腺癌患者，至少接受 2 年 AS 治疗，且国际泌尿病理学会评分系统（International Society of Urological Pathology）分级分组为 3 级或更低（Gleason 评分最高为 4+3=7）。主要观察指标：在诊断后 2 年内至少进行 3 次前列腺特异性抗原 (PSA) 测量和至少 1 次活检，以评估 AS 方案的依从性。结果：在符合分析条件的 1635 名男性中，433 名（26.5%）符合 AS 方案。多变量模型中的显著预测因素是在私立医院（与公立医院相比，调整优势比 [aOR]，1.83；95%置信区间，1.42-2.37；P<0.001）而非公立医院诊断。非依从的显著预测因素包括经尿道前列腺切除术（与经直肠超声活检 [TRUS] 相比，OR，0.54；95%置信区间，0.39-0.77；P<0.001）或经会阴活检（与 TRUS 相比，OR，0.32；95%置信区间，0.19-0.52；P<0.001）诊断以及诊断时年龄 66 岁或以上（与 <55 岁相比，OR，0.65；95%置信区间，0.45-0.92；P=0.015）。结论：近四分之三患有低疾病进展风险前列腺癌的男性未接受符合 AS 标准方案的随访检查。这种缺陷的临床后果尚不清楚。
