Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Cancer Med. 2020 Oct;9(19):6946-6953. doi: 10.1002/cam4.3341. Epub 2020 Aug 5.
The rate of primary and secondary treatment while on active surveillance (AS) for localized prostate cancer at the general population level is unknown. Our objective was to determine the patterns of secondary treatments after primary surgery or radiation for patients who undergo AS.
This was a population-based retrospective cohort study of men aged 50-80 years old in Ontario, Canada, between 2008 and 2016. We identified 26 742 patients with prostate cancer, a Gleason grade score ≤7, and an index prostate-specific antigen ≤10 ng/mL. Patients were categorized as undergoing AS with or without delayed primary treatment (DT; treatment >6 months after diagnosis) versus immediate treatment (IT; treatment ≤6 months). Patients receiving DT and IT were propensity score matched and the rate of secondary treatment (surgery or radiation ± androgen deprivation treatment) was compared using Cox proportional hazards models.
We identified 10 214 patients who underwent AS and 11 884 patients who underwent IT. Among patients undergoing AS, 3724 (36.5%) eventually underwent DT and among them, 406 (10.9%) underwent secondary treatment. The median time to DT was 1.2 years (IQR 0.5-8.1 years). The relative rate of undergoing secondary treatment was similar in the DT vs IT group (HR 0.92; 95% CI: 0.79-1.08). The risk of death in the DT group was higher compared to patients who did not undergo treatment (HR 1.23, 95% CI: 1.01-1.49).
Among patients with localized prostate cancer on AS, one third undergo DT. The rate of secondary treatment was similar between the DT and IT groups. Patients in the DT group may experience a higher risk of mortality compared to those who remained on AS.
在一般人群中，接受主动监测（AS）的局限性前列腺癌患者进行初级和二级治疗的比例尚不清楚。我们的目的是确定接受 AS 的患者接受初级手术后或放疗后进行二级治疗的模式。
这是一项基于人群的回顾性队列研究，纳入了 2008 年至 2016 年期间加拿大安大略省 50-80 岁的男性患者。我们共确定了 26742 名前列腺癌患者，其 Gleason 评分≤7，指数前列腺特异性抗原≤10ng/ml。患者分为接受 AS 治疗（有或无延迟初级治疗（DT；诊断后>6 个月治疗）或立即治疗（IT；治疗≤6 个月）。接受 DT 和 IT 的患者进行倾向评分匹配，并使用 Cox 比例风险模型比较二级治疗（手术或放疗+雄激素剥夺治疗）的发生率。
我们确定了 10214 名接受 AS 治疗的患者和 11884 名接受 IT 治疗的患者。在接受 AS 治疗的患者中，3724 名（36.5%）最终接受 DT，其中 406 名（10.9%）接受了二级治疗。DT 的中位时间为 1.2 年（IQR 0.5-8.1 年）。DT 组和 IT 组的二级治疗相对发生率相似（HR 0.92；95%CI：0.79-1.08）。与未接受治疗的患者相比，DT 组的死亡风险更高（HR 1.23，95%CI：1.01-1.49）。
在接受 AS 治疗的局限性前列腺癌患者中，有三分之一接受 DT。DT 组和 IT 组的二级治疗发生率相似。与继续接受 AS 治疗的患者相比，DT 组的患者可能面临更高的死亡风险。
