Sherer Michael V, Leonard Austin J, Nelson Tyler J, Courtney P Travis, Guram Kripa, Rodrigues De Moraes Gustavo, Javier-Desloges Juan, Kane Christopher, McKay Rana R, Rose Brent S, Bagrodia Aditya
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA.
VA San Diego Healthcare System, La Jolla, CA, USA.
Eur Urol Open Sci. 2023 Feb 20;50:61-67. doi: 10.1016/j.euros.2023.02.002. eCollection 2023 Apr.
Guidelines suggest that active surveillance (AS) may be considered for select patients with favorable intermediate-risk (fIR) prostate cancer.
To compare the outcomes between fIR prostate cancer patients included by Gleason score (GS) or prostate-specific antigen (PSA). Most patients are classified with fIR disease due to either a 3 + 4 = 7 GS (fIR-GS) or a PSA level of 10-20 ng/ml (fIR-PSA). Previous research suggests that inclusion by GS 7 may be associated with worse outcomes.
We conducted a retrospective cohort study of US veterans diagnosed with fIR prostate cancer from 2001 to 2015.
We compared the incidence of metastatic disease, prostate cancer-specific mortality (PCSM), all-cause mortality (ACM), and receipt of definitive treatment between fIR-PSA and fIR-GS patients managed with AS. Outcomes were compared with those of a previously published cohort of patients with unfavorable intermediate-risk disease using cumulative incidence function and Gray's test for statistical significance.
The cohort included 663 men; 404 had fIR-GS (61%) and 249 fIR-PSA (39%). There was no evidence of difference in the incidence of metastatic disease (8.6% vs 5.8%, = 0.77), receipt of definitive treatment (77.6% vs 81.5%, = 0.43), PCSM (5.7% vs 2.5%, = 0.274), and ACM (16.8% vs 19.1%, = 0.14) between the fIR-PSA and fIR-GS groups at 10 yr. On multivariate regression, unfavorable intermediate-risk disease was associated with higher rates of metastatic disease, PCSM, and ACM. Limitations included varying surveillance protocols.
There is no evidence of difference in oncological and survival outcomes between men with fIR-PSA and fIR-GS prostate cancer undergoing AS. Thus, presence of GS 7 disease alone should not exclude patients from consideration of AS. Shared decision-making should be utilized to optimize management for each patient.
In this report, we compared the outcomes of men with favorable intermediate-risk prostate cancer in the Veterans Health Administration. We found no significant difference between survival and oncological outcomes.
指南建议，对于部分具有有利中危（fIR）前列腺癌的患者，可考虑进行主动监测（AS）。
比较根据 Gleason 评分（GS）或前列腺特异性抗原（PSA）纳入的 fIR 前列腺癌患者的预后。大多数患者因 Gleason 评分为 3 + 4 = 7（fIR-GS）或 PSA 水平为 10 - 20 ng/ml（fIR-PSA）而被归类为 fIR 疾病。先前的研究表明，按 GS 7 纳入可能与更差的预后相关。
设计、设置和参与者：我们对 2001 年至 2015 年被诊断为 fIR 前列腺癌的美国退伍军人进行了一项回顾性队列研究。
我们比较了接受 AS 治疗的 fIR-PSA 和 fIR-GS 患者之间转移性疾病的发生率、前列腺癌特异性死亡率（PCSM）、全因死亡率（ACM）以及确定性治疗的接受情况。使用累积发病率函数和 Gray 检验比较结果与先前发表的一组具有不利中危疾病患者的结果，以确定统计学意义。
该队列包括 663 名男性；404 例为 fIR-GS（61%），249 例为 fIR-PSA（39%）。在 10 年时，fIR-PSA 和 fIR-GS 组之间在转移性疾病发生率（8.6% 对 5.8%，P = 0.77）、接受确定性治疗（77.6% 对 81.5%，P = 0.43）、PCSM（5.7% 对 2.5%，P = 0.274）和 ACM（16.8% 对 19.1%，P = 0.14）方面没有差异的证据。在多变量回归中，不利的中危疾病与更高的转移性疾病、PCSM 和 ACM 发生率相关。局限性包括不同的监测方案。
没有证据表明接受 AS 治疗的 fIR-PSA 和 fIR-GS 前列腺癌男性在肿瘤学和生存结果方面存在差异。因此，仅存在 GS 7 疾病不应排除患者考虑 AS。应采用共同决策来优化每位患者的管理。
在本报告中，我们比较了退伍军人健康管理局中具有有利中危前列腺癌男性的预后。我们发现生存和肿瘤学结果之间没有显著差异。
