Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, 07103, USA.
Cancer Institute of New Jersey, Newark, NJ, USA.
Curr Urol Rep. 2023 Jul;24(7):307-315. doi: 10.1007/s11934-023-01158-5. Epub 2023 Mar 30.
The purpose of this review is to investigate the current use and effectiveness of active surveillance (AS) for clinical low-risk prostate cancer (PCa) in men considered to be "high-risk" based on the factors of race, genetics, healthcare access, and socioeconomic status.
Advances in molecular biomarkers and imaging have improved the detection, risk stratification, and treatment of PCa. Still, overdiagnosis and overtreatment of indolent disease remain a concern. AS is therefore the preferred option for clinical low-risk disease. Yet, because of the variability in PCa presentation based on the aforementioned environmental and genetic factors, the question remains: Is active surveillance a safe option for everyone? Provider hesitancy should not necessarily exclude high-risk men from participating in AS. Rather, clinicians should employ shared decision-making, sound clinical judgment, and stringent follow-up in order to effectively counsel AS candidates and optimize AS-related outcomes in "high-risk" individuals.
本综述旨在探讨主动监测（AS）在种族、遗传、医疗保健可及性和社会经济地位等因素被认为“高危”的男性临床低危前列腺癌（PCa）中的当前应用和效果。
分子生物标志物和影像学的进步提高了 PCa 的检测、风险分层和治疗水平。然而，过度诊断和过度治疗惰性疾病仍然令人担忧。因此，AS 是临床低危疾病的首选方案。然而，由于基于上述环境和遗传因素的 PCa 表现存在差异，问题仍然存在：主动监测对每个人都是安全的选择吗？提供者的犹豫不应该理所当然地将高危男性排除在主动监测之外。相反，临床医生应该采用共同决策、良好的临床判断和严格的随访，以便有效地为主动监测候选人提供咨询，并优化“高危”个体的主动监测相关结果。
