Chin Joel Li Ji, Tan Yu Guang, Low Alvin Wei Xiang, Chen Kenneth, Ho Henry Sun Sien, Cheng Christopher Wai Sam, Yuen John Shyi Peng, Tay Kae Jack
Department of Urology, Singapore General Hospital, SingHealth, Singapore, Singapore.
Transl Androl Urol. 2024 Nov 30;13(11):2459-2467. doi: 10.21037/tau-24-322. Epub 2024 Nov 27.
Management of localised prostate cancer (PCa) remains controversial in the era of prostate-specific antigen (PSA) testing. This study aims to describe the natural history of men with PCa being followed up expectantly to evaluate disease mortality.
After exclusion, clinical data of 204 patients retrieved from a prospective large PCa registry were reviewed. Competing risk analysis were performed using the Fine-Gray model.
The median age was 73 years old with a median follow up of 12.5 years. The median PSA was 8.85 ng/mL and the risk stratification were as follows: low (47.0%), intermediate (31.4%), and high risk (21.6%). There were 19 PCa (9.3%) and 84 non-PCa deaths (41.2%), with overall mortality at 50.5%. Multivariate analysis showed patients with high PSA values [subdistribution hazard ratio (sdHR) 7.13], poorer prostate cancer grade groups (PCGG) (sdHR 16.349), and therefore higher European Association of Urology risk group (sdHR 11.42) had greatly elevated prostate cancer mortality (PCM). Older patients greater than 75 years of age (sdHR 4.52) and high Charlson Comorbidity Index (CCI ≥6) scores had higher non-prostate cancer mortality (NPCM) (sdHR 7.87). Subgroup analysis of the high-risk group showed having a lower CCI score (≤3) had a greater risk of PCM than NPCM (sdHR 4.31 0.22) while the converse is observed for higher CCI scores (1.12 5.52).
Overall PCM remains low in elderly men with conservatively treated PCa. Age and poorer CCI predict NPCM while PSA and PCGG predict PCM. In high-risk PCa group, CCI is a useful tool to determine which patients will benefit from radical treatment.
在前列腺特异性抗原（PSA）检测时代，局限性前列腺癌（PCa）的管理仍存在争议。本研究旨在描述接受期待性随访的PCa男性患者的自然病程，以评估疾病死亡率。
排除后，回顾了从一个前瞻性大型PCa登记处检索到的204例患者的临床数据。使用Fine-Gray模型进行竞争风险分析。
中位年龄为73岁，中位随访时间为12.5年。中位PSA为8.85 ng/mL，风险分层如下：低风险（47.0%）、中风险（31.4%）和高风险（21.6%）。有19例PCa死亡（9.3%）和84例非PCa死亡（41.2%），总死亡率为50.5%。多变量分析显示，PSA值高的患者[亚分布风险比（sdHR）7.13]、前列腺癌分级组（PCGG）较差的患者（sdHR 16.349），因此欧洲泌尿外科协会风险组较高的患者（sdHR 11.42）前列腺癌死亡率（PCM）大幅升高。75岁以上的老年患者（sdHR 4.52）和高Charlson合并症指数（CCI≥6）评分的患者非前列腺癌死亡率（NPCM）较高（sdHR 7.87）。高风险组的亚组分析显示，CCI评分较低（≤3）的患者PCM风险高于NPCM（sdHR 4.31对0.22），而CCI评分较高时则相反（1.12对5.52）。
接受保守治疗的老年PCa男性患者的总体PCM仍然较低。年龄和较差的CCI可预测NPCM，而PSA和PCGG可预测PCM。在高风险PCa组中，CCI是确定哪些患者将从根治性治疗中获益的有用工具。
