Fernández-Conejo G, de la Peña E, Hernández V, Pérez-Fernández E, Llorente C
Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
Actas Urol Esp (Engl Ed). 2019 Sep;43(7):378-383. doi: 10.1016/j.acuro.2018.10.002. Epub 2019 Jun 3.
The world population is ageing, and life expectancy is increasing. This situation will have a great impact on the management of patients with prostate cancer, especially in those of low risk, susceptible to a conservative management under active surveillance (AS). Regarding these patients' profile, it is necessary to answer the following questions: ¿for how long to continue with the AS scheme?, ¿which tests will be required?, ¿is it possible to carry out a transition to observation with oncological safety? The objective of this work is to analyse those patients with prostatic cancer who have been in AS with 75 years of age or more and assess the safety of the observation in an AS series with a long follow-up.
We analysed our prospective cohort of AS patients between the years 1999 and 2018,including those who had been in follow-up with 75 years or more. They were offered treatment with curative intent when there were progression criteria and transition to observation under the urologist's decision. Some intermediate risk patients were included in the analysis. Comorbidity changes were analysed with the Charlson comorbidity index at entry and exit of AS. The progression and mortality of the patients were studied according to the management they received.
From 347 AS patients, 90 patients fulfilled the afore mentioned criteria and 15 (16.7%) were intermediate risk. The median follow-up was 6.4 years and 73 (81.1%) had low comorbidity (Charlson<2).There were 40 (44.4%) patients who left AS, 17 (18.9%) of them went to observationand the rest, 21 (23.3%), received curative treatment. There was a significant difference in comorbidity, measured by the Charlson index, at entry and exit of AS (P<.05) among patients receiving active treatment and the ones submitted to observation.No case of cancer-specific death or progression was observed in the observation group.
The transition from an active surveillance management to observation of prostate cancer elderly patients, as well as the decision to carry out a treatment with curative intent, seems controversial. In our series, this transition in patients older than 75 years does not increase the oncological risk.
世界人口正在老龄化，预期寿命在增加。这种情况将对前列腺癌患者的管理产生重大影响，尤其是对那些低风险、易于在主动监测（AS）下进行保守管理的患者。关于这些患者的情况，有必要回答以下问题：AS方案要持续多久？需要哪些检查？是否有可能在肿瘤学安全的情况下过渡到观察？这项工作的目的是分析那些75岁及以上接受AS治疗的前列腺癌患者，并评估在长期随访的AS系列中观察的安全性。
我们分析了1999年至2018年间我们的AS患者前瞻性队列，包括那些随访年龄在75岁及以上的患者。当有进展标准时，他们接受了根治性治疗，并根据泌尿科医生的决定过渡到观察。分析中纳入了一些中危患者。在AS开始和结束时，用Charlson合并症指数分析合并症变化。根据患者接受的管理方式研究其进展和死亡率。
在347例AS患者中，90例符合上述标准，15例（16.7%）为中危。中位随访时间为6.4年，73例（81.1%）合并症较低（Charlson<2）。有40例（44.4%）患者退出AS，其中17例（18.9%）转为观察，其余21例（23.3%）接受了根治性治疗。接受积极治疗的患者和接受观察的患者在AS开始和结束时，用Charlson指数衡量的合并症有显著差异（P<.05）。观察组未观察到癌症特异性死亡或进展病例。
从积极监测管理过渡到对老年前列腺癌患者的观察，以及进行根治性治疗的决定，似乎存在争议。在我们的系列研究中，75岁以上患者的这种过渡不会增加肿瘤学风险。
