Albertsen P C, Hanley J A, Gleason D F, Barry M J
Division of Urology, University of Connecticut Health Center, Farmington 06030-3955, USA.
JAMA. 1998 Sep 16;280(11):975-80. doi: 10.1001/jama.280.11.975.
The appropriate therapy for men with localized prostate cancer is uncertain. Until results of clinical trials are available, men and their physicians need guidance.
To estimate survival based on a competing risk analysis stratified by age at diagnosis and histologic findings for men diagnosed as having clinically localized prostate cancer and who were managed conservatively.
Retrospective cohort study.
Connecticut Tumor Registry.
A total of 767 men with localized prostate cancer diagnosed between 1971 and 1984, aged 55 to 74 years at diagnosis, either not treated or treated with immediate or delayed hormonal therapy, and followed up for 10 to 20 years after diagnosis.
Estimates of the probability of dying from prostate cancer or other competing hazards.
Men with tumors that have Gleason scores of 2 to 4, 5, 6, 7, and 8 to 10 face a 4% to 7%, 6% to 11%, 18% to 30%, 42% to 70%, and 60% to 87% chance, respectively, of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis.
Men whose prostate biopsy specimens show Gleason score 2 to 4 disease face a minimal risk of death from prostate cancer within 15 years of diagnosis. Conversely, men whose biopsy specimens show Gleason score 7 to 10 disease face a high risk of death from prostate cancer when treated conservatively, even when cancer is diagnosed as late as age 74 years. Men with Gleason score 5 or 6 tumors face a modest risk of death from prostate cancer that increases slowly over at least 15 years of follow-up.
局部前列腺癌男性患者的适当治疗方法尚不确定。在获得临床试验结果之前，男性患者及其医生需要指导。
基于竞争风险分析，根据诊断时的年龄和组织学结果进行分层，估计被诊断为临床局限性前列腺癌且接受保守治疗的男性患者的生存率。
回顾性队列研究。
康涅狄格肿瘤登记处。
共有767名1971年至1984年间被诊断为局限性前列腺癌的男性患者，诊断时年龄在55至74岁之间，未接受治疗或接受了即时或延迟激素治疗，并在诊断后随访10至20年。
死于前列腺癌或其他竞争风险的概率估计值。
根据诊断时的年龄，Gleason评分为2至4、5、6、7以及8至10的肿瘤男性患者，在诊断后15年内死于前列腺癌的几率分别为4%至7%、6%至11%、18%至30%、42%至70%以及60%至87%。
前列腺活检标本显示Gleason评分为2至4级疾病的男性患者，在诊断后15年内死于前列腺癌的风险极小。相反，活检标本显示Gleason评分为7至10级疾病的男性患者，即使在74岁才被诊断出癌症，保守治疗时死于前列腺癌的风险也很高。Gleason评分为5或6级肿瘤的男性患者死于前列腺癌的风险适中，且在至少15年的随访中缓慢增加。
