Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2020 Jun;203(6):1117-1121. doi: 10.1097/JU.0000000000000742. Epub 2020 Jan 7.
We studied the risk of metastatic prostate cancer development in men with Grade Group 2 disease managed with active surveillance at Memorial Sloan Kettering Cancer Center.
A total of 219 men with Grade Group 2 prostate cancer had disease managed with active surveillance between 2000 and 2017. Biopsy was performed every 2 to 3 years, or upon changes in magnetic resonance imaging, prostate specific antigen level or digital rectal examination. The primary outcome was development of distant metastasis. The Kaplan-Meier method was used to estimate treatment-free survival.
Median age at diagnosis was 67 years (IQR 61-72), median prostate specific antigen was 5 ng/ml (IQR 4-7) and most patients (69%) had nonpalpable disease. During followup 64 men received treatment, including radical prostatectomy in 36 (56%), radiotherapy in 20 (31%), hormone therapy in 3 (5%) and focal therapy in 5 (8%). Of the 36 patients who underwent radical prostatectomy 32 (89%) had Grade Group 2 disease on pathology and 4 (11%) had Grade Group 3 disease. Treatment-free survival was 61% (95% CI 52-70) at 5 years and 49% (95% CI 37-60) at 10 years. Three men experienced biochemical recurrence, no men had distant metastasis and no men died of prostate cancer during the followup. Median followup was 3.1 years (IQR 1.9-4.9).
Active surveillance appears to be a safe initial management strategy in the short term for carefully selected and closely monitored men with Grade Group 2 prostate cancer treated at a tertiary cancer center. Definitive conclusions await further followup.
我们研究了在纪念斯隆凯特琳癌症中心接受主动监测治疗的 2 级疾病患者发生转移性前列腺癌的风险。
共有 219 名患有 2 级前列腺癌的男性在 2000 年至 2017 年间接受主动监测治疗。每 2-3 年进行一次活检，或在 MRI、前列腺特异性抗原水平或直肠指检发生变化时进行活检。主要结局是远处转移的发生。使用 Kaplan-Meier 方法估计无治疗生存。
中位诊断年龄为 67 岁（IQR 61-72），中位前列腺特异性抗原为 5ng/ml（IQR 4-7），大多数患者（69%）患有不可触及的疾病。在随访期间，64 名男性接受了治疗，包括根治性前列腺切除术 36 例（56%）、放疗 20 例（31%）、激素治疗 3 例（5%）和局灶治疗 5 例（8%）。在接受根治性前列腺切除术的 36 名患者中，32 名（89%）的病理分级为 2 级，4 名（11%）的病理分级为 3 级。5 年时无治疗生存率为 61%（95%CI 52-70），10 年时无治疗生存率为 49%（95%CI 37-60）。3 名男性出现生化复发，无远处转移，无男性在随访期间死于前列腺癌。中位随访时间为 3.1 年（IQR 1.9-4.9）。
在短期内，主动监测似乎是一种安全的初始管理策略，适用于在三级癌症中心接受治疗的精心挑选和密切监测的 2 级前列腺癌男性。进一步随访有待进一步明确结论。
