Copenhagen Prostate Cancer Center, Copenhagen, Denmark.
Departments of Urology, Herlev and Gentofte Hospital, Herlev, Denmark.
J Urol. 2019 Mar;201(3):520-527. doi: 10.1016/j.juro.2018.09.045.
The objective of this study was to investigate nationwide survival outcomes in men with localized prostate cancer managed on active surveillance.
A total of 936 men with localized prostate cancer were initiated on active surveillance in Denmark in 2002 to 2012. Kaplan-Meier estimated curative treatment-free, hormonal therapy-free, castration resistant prostate cancer-free and cause specific survival was calculated.
Prostate cancer was classified as very low risk in 223 men, low risk in 436, intermediate risk in 259 (87% were at favorable intermediate risk) and high risk in 18. Median followup was 7.5 years (IQR 6.1-9.1). Kaplan-Meier estimated 10-year curative treatment-free survival was 62.8% (95% CI 59.1-66.3), 10-year hormonal therapy-free survival was 92.2% (95% CI 89.2-94.4), 10-year castration resistant prostate cancer-free survival was 97.2% (95% CI 95.3-98.4) and 10-year cause specific survival was 99.6% (95% CI 98.6-99.9). Compared to men with low risk prostate cancer, those with intermediate risk prostate cancer had higher curative treatment-free survival (69% vs 56%, p = 0.008), lower hormonal therapy-free survival (88% vs 95%, p = 0.005) and similar castration resistant prostate cancer-free survival (95% vs 99%, p = 0.17).
In this nationwide cohort 10-year cause specific survival was similar to that in prospective active surveillance cohorts. Our study supports the use of active surveillance in men with localized prostate cancer, including men with favorable intermediate risk characteristics.
本研究旨在调查在丹麦接受主动监测的局限性前列腺癌男性的全国性生存结果。
2002 年至 2012 年，丹麦共有 936 名局限性前列腺癌患者开始接受主动监测。采用 Kaplan-Meier 估计治愈性无治疗、激素治疗无、去势抵抗性前列腺癌无和特定原因生存。
223 名患者前列腺癌被归类为极低危，436 名患者为低危，259 名患者为中危（87%为有利中危），18 名患者为高危。中位随访时间为 7.5 年（IQR 6.1-9.1）。Kaplan-Meier 估计 10 年治愈性无治疗生存率为 62.8%（95%CI 59.1-66.3），10 年激素治疗无生存率为 92.2%（95%CI 89.2-94.4），10 年去势抵抗性前列腺癌无生存率为 97.2%（95%CI 95.3-98.4），10 年特定原因生存率为 99.6%（95%CI 98.6-99.9）。与低危前列腺癌患者相比，中危前列腺癌患者的治愈性无治疗生存率更高（69% vs 56%，p = 0.008），激素治疗无生存率更低（88% vs 95%，p = 0.005），去势抵抗性前列腺癌无生存率相似（95% vs 99%，p = 0.17）。
在本全国性队列中，10 年特定原因生存率与前瞻性主动监测队列相似。我们的研究支持在局限性前列腺癌患者中使用主动监测，包括具有有利中危特征的患者。
