Mukherjee Subhabrata, Promponas Ioannis, Petrides Neophytos, Hossain Dafader, Abbaraju Jayasimha, Madaan Sanjeev
Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK.
Eur Urol Open Sci. 2021 Jan 8;24:17-24. doi: 10.1016/j.euros.2020.12.005. eCollection 2021 Feb.
Although active surveillance (AS) is a well-recognised treatment option for localised low-risk prostate cancer (LRPC), its role in the management of localised intermediate-risk prostate cancer (IRPC) is not clear yet and the available literature is slightly contradictory.
To compare the outcome of AS between LRPC and IRPC patients.
Between November 2002 and August 2019, 372 men with localised prostate cancer (PC) underwent AS in our hospital based on local departmental protocol.
The primary outcome measures were overall survival, disease progression-free survival, treatment-free survival, and biochemical recurrence-free survival. Survival times in the low- and intermediate-risk groups were compared using Cox regression analysis.
Out of 372 localised PC patients, 276 (74%) had LRPC and 96 (26%) IRPC. Overall, 86 (31.2%) low-risk and 25 (26%) intermediate-risk patients developed disease progression, and 86 (31.2%) low-risk and 22 (23%) intermediate-risk patients underwent active treatment. Among the treated patients, eight (2.9%) LRPC patients and one (1%) IRPC patient developed biochemical recurrence. In total, only one patient (from the low-risk group) had metastasis and 25 patients passed away (18 from the low-risk and seven from the intermediate-risk group). No death was recorded due to PC in the cohort. There was no difference in any of the survival outcomes between LRPC and IRPC patients in unadjusted analysis as well as when analysis was performed after adjusting the potentially confounding factors. Limitations include relatively short median follow-up time and failure to objectively define the criteria for the selection of IRPC patients suitable for AS.
The option of AS could be considered for carefully selected and well-informed patients with IRPC provided close structured monitoring is maintained.
In this report, we looked at various survival outcomes of active surveillance between low- and intermediate-risk prostate cancer patients in a large British population. There was no difference in any of the survival outcomes between the two groups. We concluded that carefully selected intermediate-risk prostate cancer patients could be offed the option of active surveillance.
尽管主动监测（AS）是局限性低风险前列腺癌（LRPC）公认的治疗选择，但其在局限性中风险前列腺癌（IRPC）管理中的作用尚不清楚，现有文献也略有矛盾。
比较LRPC和IRPC患者的主动监测结果。
设计、设置和参与者：2002年11月至2019年8月期间，372例局限性前列腺癌（PC）患者在我院根据当地部门方案接受了主动监测。
主要结果测量指标为总生存期、无疾病进展生存期、无治疗生存期和无生化复发生存期。使用Cox回归分析比较低风险和中风险组的生存时间。
在372例局限性PC患者中，276例（74%）为LRPC，96例（26%）为IRPC。总体而言，86例（31.2%）低风险和25例（26%）中风险患者出现疾病进展，86例（31.2%）低风险和22例（23%）中风险患者接受了积极治疗。在接受治疗的患者中，8例（2.9%）LRPC患者和1例（1%）IRPC患者出现生化复发。总共只有1例患者（来自低风险组）发生转移，25例患者死亡（18例来自低风险组，7例来自中风险组）。该队列中没有因PC死亡的记录。在未调整分析以及在调整潜在混杂因素后进行分析时，LRPC和IRPC患者在任何生存结果方面均无差异。局限性包括中位随访时间相对较短，以及未能客观定义适合主动监测的IRPC患者的选择标准。
对于经过精心挑选且充分知情的IRPC患者，若能维持密切的结构化监测，可考虑采用主动监测方案。
在本报告中，我们研究了英国一大群低风险和中风险前列腺癌患者主动监测的各种生存结果。两组在任何生存结果方面均无差异。我们得出结论，经过精心挑选的中风险前列腺癌患者可以选择主动监测方案。
