Department of Urology, Harvard Medical School , Boston , Massachusetts.
Division of Urology, Department of Surgery, Brigham and Women's Hospital , Boston , Massachusetts.
J Urol. 2019 Apr;201(4):721-727. doi: 10.1097/JU.0000000000000031.
At most centers strict age criteria are lacking for eligibility for active surveillance of prostate cancer. Younger men are often counseled to undergo definitive treatment despite limited data on the outcomes of active surveillance in younger men. We compared clinical characteristics and outcomes in men who enrolled in active surveillance at age less than 60 vs 60 years old or older.
We retrospectively reviewed the records of 2 institutional cohorts of a total of 2,084 men in whom prostate cancer was managed by active surveillance between 1995 and 2016. We compared outcomes in men who began active surveillance at age 60 vs 60 years or older using the Kaplan-Meier method and Cox proportional hazards regression.
We identified 417 and 1,667 men who began active surveillance at younger than 60 and 60 years old or older, respectively, who met study inclusion criteria. At a median followup of 6.2 years we found no significant difference between men younger than 60 and 60 years old or older in the 5-year rates of biopsy progression-free survival (83% vs 83%), treatment-free survival (74% vs 71%), metastasis-free survival (99.7% vs 99.0%) or prostate cancer specific survival (100% vs 99.7%). Of the younger men 131 (31%) ultimately underwent treatment, including for pathological progression in 67% and prostate specific antigen progression in 18%. On multivariate analysis significant predictors of biopsy progression and progression to treatment among younger men were 20% or greater involvement of any core on diagnostic biopsy (HR 2.21, p = 0.003) and prostate specific antigen density 0.15 ng/ml/ml or greater (HR 1.93, p = 0.01).
Active surveillance is a viable option in select men younger than 60 years with low volume, low risk prostate cancer. However, patients must be surveyed closely and understand the significant likelihood of ultimately requiring treatment.
在大多数中心，前列腺癌主动监测的入选标准缺乏严格的年龄限制。尽管年轻男性主动监测的结果数据有限，但年轻男性通常被建议接受确定性治疗。我们比较了年龄小于 60 岁和年龄大于等于 60 岁接受主动监测的男性的临床特征和结局。
我们回顾性地分析了 1995 年至 2016 年期间通过主动监测管理的 2 个机构队列共 2084 名男性的记录。我们使用 Kaplan-Meier 方法和 Cox 比例风险回归比较了年龄在 60 岁及以上开始主动监测的男性和年龄在 60 岁以下开始主动监测的男性的结局。
我们确定了 417 名和 1667 名年龄分别小于 60 岁和 60 岁及以上开始主动监测的男性，他们符合研究纳入标准。在中位随访 6.2 年后，我们发现年龄小于 60 岁和 60 岁及以上的男性在 5 年的活检无进展生存（83% vs 83%）、无治疗生存（74% vs 71%）、无转移生存（99.7% vs 99.0%）和前列腺癌特异性生存（100% vs 99.7%）方面没有显著差异。在年轻男性中，有 131 名（31%）最终接受了治疗，其中 67%是因为病理进展，18%是因为前列腺特异性抗原进展。多因素分析显示，年轻男性活检进展和进展至治疗的显著预测因素是诊断性活检中任何核心有 20%或更多受累（HR 2.21，p = 0.003）和前列腺特异性抗原密度为 0.15ng/ml/ml 或更高（HR 1.93，p = 0.01）。
对于低体积、低风险的前列腺癌，主动监测是年龄小于 60 岁的男性的一种可行选择。然而，患者必须接受密切监测，并了解最终需要治疗的可能性很大。
