Department of Urology, University of Washington, Seattle, Washington.
Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Cancer. 2022 Jan 15;128(2):269-274. doi: 10.1002/cncr.33911. Epub 2021 Sep 13.
Maintaining men on active surveillance for prostate cancer can be challenging. Although most men who eventually undergo treatment have experienced clinical progression, a smaller subset elects treatment in the absence of disease reclassification. This study sought to understand factors associated with treatment in a large, contemporary, prospective cohort.
This study identified 1789 men in the Canary Prostate Cancer Active Surveillance Study cohort enrolled as of 2020 with a median follow-up of 5.6 years. Clinical and demographic data as well as information on patient-reported quality of life and urinary symptoms were used in multivariable Cox proportional hazards regression models to identify factors associated with the time to treatment RESULTS: Within 4 years of their diagnosis, 33% of men (95% confidence interval [CI], 30%-35%) underwent treatment, and 10% (95% CI, 9%-12%) were treated in the absence of reclassification. The most significant factor associated with any treatment was an increasing Gleason grade group (adjusted hazard ratio [aHR], 14.5; 95% CI, 11.7-17.9). Urinary quality-of-life scores were associated with treatment without reclassification (aHR comparing "mostly dissatisfied/terrible" with "pleased/mixed," 2.65; 95% CI, 1.54-4.59). In a subset analysis (n = 692), married men, compared with single men, were more likely to undergo treatment in the absence of reclassification (aHR, 2.63; 95% CI, 1.04-6.66).
A substantial number of men with prostate cancer undergo treatment in the absence of clinical changes in their cancers, and quality-of-life changes and marital status may be important factors in these decisions.
This analysis of men on active surveillance for prostate cancer shows that approximately 1 in 10 men will decide to be treated within 4 years of their diagnosis even if their cancer is stable. These choices may be related in part to quality-or-life or spousal concerns.
对前列腺癌进行主动监测的男性可能会面临挑战。尽管大多数最终接受治疗的男性都经历了临床进展，但一小部分男性在疾病未重新分类的情况下选择了治疗。本研究旨在了解在一个大型、现代、前瞻性队列中与治疗相关的因素。
本研究在截至 2020 年的 Canary 前列腺癌主动监测研究队列中确定了 1789 名男性患者，中位随访时间为 5.6 年。多变量 Cox 比例风险回归模型中使用了临床和人口统计学数据以及患者报告的生活质量和尿症状信息，以确定与治疗时间相关的因素。
在诊断后的 4 年内，33%的男性（95%置信区间[CI]，30%-35%）接受了治疗，10%（95%CI，9%-12%）在未重新分类的情况下接受了治疗。与任何治疗最显著相关的因素是 Gleason 分级组的增加（调整后的危险比[aHR]，14.5；95%CI，11.7-17.9）。尿生活质量评分与未经重新分类的治疗有关（比较“大多不满意/糟糕”与“满意/混合”的 aHR，2.65；95%CI，1.54-4.59）。在亚组分析（n=692）中，与单身男性相比，已婚男性更有可能在未经重新分类的情况下接受治疗（aHR，2.63；95%CI，1.04-6.66）。
相当数量的前列腺癌男性在癌症没有临床变化的情况下接受治疗，生活质量变化和婚姻状况可能是这些决定的重要因素。
对前列腺癌进行主动监测的男性分析表明，大约每 10 名男性中就有 1 名将在诊断后 4 年内决定接受治疗，即使他们的癌症处于稳定状态。这些选择可能部分与生活质量或配偶的担忧有关。
