Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.
Department of Urology, Turku University Hospital, Turku, Finland.
BMC Urol. 2020 Mar 12;20(1):25. doi: 10.1186/s12894-020-00593-7.
Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment.
Men aged ≥70 years (n = 16,534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70-79 years and ≥ 80 years) and three calendar time cohorts (1985-1994, 1995-2004, and 2005-2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015.
Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70-79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29-2.23 [1985-1994]; RR 1.55, 95% CI: 1.35-1.84 [1995-2004]; and RR 2.71, 95% CI: 2.08-3.53 [2005-2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged > 80 years; (p for age-period interaction = 0.237). Overall survival was also higher among men in their 70's managed by observation compared to those undergoing ADT.
Primary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study's conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.
尽管没有证据表明雄激素剥夺疗法（ADT）在没有治愈性治疗的情况下有益，但它仍然是局限性前列腺癌（PCa）的主要治疗方法。
纳入了 1985 年至 2014 年间诊断为局限性 PCa 的年龄≥70 岁（n=16534）的男性，这些患者接受了主动监测或 ADT 治疗，但没有接受治愈性治疗。这些病例是从基于人群的芬兰癌症登记处确定的。我们根据治疗组估计了全因死亡率的标准化死亡率比（SMR）。我们确定了两组治疗方法之间的前列腺癌特异性死亡率（PCSM）和其他原因死亡率的相对风险（RR）。使用寿命表法确定生存情况。两组年龄组（70-79 岁和≥80 岁）和三个日历时间队列（1985-1994 年、1995-2004 年和 2005-2014 年）在调整了治疗组之间的倾向评分匹配后，使用四个协变量（年龄、诊断年份、教育水平和医院区）进行比较。随访一直持续到死亡或 2015 年 12 月 31 日。
在整个研究期间，两个年龄组的观察组患者的总体 SMR 均低于 ADT 组。与仅接受主动监测的患者相比，70-79 岁接受原发性 ADT 的患者的 PCSM 更高（RR：1.70，95%置信区间[CI]：1.29-2.23[1985-1994 年]；RR：1.55，95%CI：1.35-1.84[1995-2004 年]；RR：2.71，95%CI：2.08-3.53[2005-2014 年]）；（周期性趋势的 p 值=0.005）。年龄>80 岁的男性也观察到了类似的时间趋势；（p 值=0.237）。与接受 ADT 的患者相比，接受主动监测的 70 岁男性的总体生存时间也更长。
与主动监测相比，局限性 PCa 男性在诊断后四个月内进行原发性 ADT 治疗与长期总体生存或 PCSM 降低无关。然而，这项观察性研究的结论应该考虑到与癌症侵袭性和合并症相关的混杂因素。
