de Vos Ivo I, Luiting Henk B, Roobol Monique J
Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
J Pers Med. 2023 Apr 3;13(4):629. doi: 10.3390/jpm13040629.
In response to the rising incidence of indolent, low-risk prostate cancer (PCa) due to increased prostate-specific antigen (PSA) screening in the 1990s, active surveillance (AS) emerged as a treatment modality to combat overtreatment by delaying or avoiding unnecessary definitive treatment and its associated morbidity. AS consists of regular monitoring of PSA levels, digital rectal exams, medical imaging, and prostate biopsies, so that definitive treatment is only offered when deemed necessary. This paper provides a narrative review of the evolution of AS since its inception and an overview of its current landscape and challenges. Although AS was initially only performed in a study setting, numerous studies have provided evidence for the safety and efficacy of AS which has led guidelines to recommend it as a treatment option for patients with low-risk PCa. For intermediate-risk disease, AS appears to be a viable option for those with favourable clinical characteristics. Over the years, the inclusion criteria, follow-up schedule and triggers for definitive treatment have evolved based on the results of various large AS cohorts. Given the burdensome nature of repeat biopsies, risk-based dynamic monitoring may further reduce overtreatment by avoiding repeat biopsies in selected patients.
由于20世纪90年代前列腺特异性抗原（PSA）筛查的增加，惰性、低风险前列腺癌（PCa）的发病率不断上升，作为一种治疗方式，主动监测（AS）应运而生，旨在通过延迟或避免不必要的确定性治疗及其相关发病率来对抗过度治疗。主动监测包括定期监测PSA水平、直肠指检、医学成像和前列腺活检，以便仅在必要时才提供确定性治疗。本文对主动监测自诞生以来的发展历程进行了叙述性综述，并概述了其当前的现状和挑战。尽管主动监测最初仅在研究环境中进行，但大量研究已为其安全性和有效性提供了证据，这使得相关指南推荐将其作为低风险PCa患者的一种治疗选择。对于中风险疾病，对于那些具有良好临床特征的患者，主动监测似乎是一种可行的选择。多年来，基于各种大型主动监测队列的结果，确定性治疗的纳入标准、随访计划和触发因素已经发生了演变。鉴于重复活检的负担性质，基于风险的动态监测可能通过避免对选定患者进行重复活检进一步减少过度治疗。
