Determining Long-term Prostate Cancer Outcomes for Active Surveillance Patients Without Early Disease Progression: Implications for Slowing or Stopping Surveillance.

IF 8.3 1区 医学 Q1 ONCOLOGY European urology oncology Pub Date : 2024-09-27 DOI:10.1016/j.euo.2024.09.008
Kevin Shee, James Nie, Janet E Cowan, Lufan Wang, Samuel L Washington, Katsuto Shinohara, Hao G Nguyen, Matthew R Cooperberg, Peter R Carroll
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Abstract

Background and objective: Active surveillance (AS) of prostate cancer (PCa) is the standard of care for low-grade disease, but there is limited guidance on tailoring protocols for stable patients. We investigated long-term outcomes for patients without initial progression and risk factors for upgrade.

Methods: Men on AS with Gleason grade group (GG) 1 PCa on three serial biopsies, ≥5 yr without progression, and ≥10 yr of follow-up were included. Outcomes were upgrade (GG ≥2), major upgrade (GG ≥3), progression to treatment, metastasis, PCa-specific survival, and overall survival. Cox proportional hazards regression models were used to estimate the associations between patient characteristics and risk of upgrade.

Key findings and limitations: A total of 774 men met the inclusion criteria. At 10, 12, and 15 yr, upgrade-free survival rates were 56%, 45%, and 21%; major upgrade-free survival rates were 88%, 83%, and 61%; treatment-free survival rates were 86%, 83%, and 73%; metastasis-free survival rates were 99%, 99%, and 98%; and overall survival rates were 98%, 96%, and 95%, respectively. PCa-specific survival was 100% at 15 yr. On a multivariable analysis, year of diagnosis, age, body mass index (BMI), and biopsy core positivity were associated with upgrade (all p < 0.01), whereas age and prostate-specific antigen (PSA) density were associated with major upgrade.

Conclusions and clinical implications: Patients without progression for 5 yr on AS had modest rates of upgrade and low rates of metastasis, and mortality at 15 yr of follow-up. Year of diagnosis, older age, increased BMI, and increased biopsy core positivity were associated with upgrade, whereas older age and greater PSA density were associated with an increased risk of major upgrade. A subset of these patients may benefit from deintensification of AS protocols.

Patient summary: There are little reported data or clinical guidelines for patients with PCa who are stable for many years on active surveillance (AS). We show, in a large cohort, that PCa patients without progression for 5 yr on AS have modest rates of upgrade and very low rates of metastasis, and mortality rates at 15 yr of follow-up, and that older age, increased body mass index, and increased PCa volume are associated with an increased likelihood of future upgrade. This study supports continued AS in this patient population and deintensification in select patients.

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确定无早期疾病进展的主动监测患者的前列腺癌长期预后:放慢或停止监测的意义。
背景和目的:前列腺癌(PCa)的主动监测(AS)是低级别疾病的标准治疗方法,但针对稳定期患者的定制方案指导有限。我们调查了没有初始进展的患者的长期治疗效果以及升级的风险因素:方法:纳入三次连续活检均为 Gleason 等级组(GG)1 PCa 的男性 AS 患者,随访≥10 年且≥5 年无进展。结果包括升级(GG ≥2)、重大升级(GG ≥3)、治疗进展、转移、PCa 特异性生存率和总生存率。Cox比例危险回归模型用于估计患者特征与升级风险之间的关系:共有 774 名男性符合纳入标准。10、12和15年后,无升级生存率分别为56%、45%和21%;无重大升级生存率分别为88%、83%和61%;无治疗生存率分别为86%、83%和73%;无转移生存率分别为99%、99%和98%;总生存率分别为98%、96%和95%。在多变量分析中,诊断年份、年龄、体重指数(BMI)和活检核心阳性率与升级(所有 p 结论和临床影响)相关:接受强直性脊柱炎治疗5年无进展的患者在随访15年时的升级率、转移率和死亡率都不高。诊断年份、年龄、体重指数(BMI)升高和活检核心阳性率升高与病情升级有关,而年龄升高和 PSA 密度升高与病情重大升级风险升高有关。这些患者中的一部分可能会从减弱主动监测方案的强度中获益。患者总结:对于多年稳定接受主动监测(AS)的 PCa 患者,几乎没有相关的数据报告或临床指南。我们在一项大型队列研究中发现,PCa 患者在接受主动监测 5 年后病情未见进展,随访 15 年后,病情升级率不高,转移率和死亡率很低,而且年龄增大、体重指数增加和 PCa 体积增大与未来病情升级的可能性增加有关。这项研究支持在这一患者群体中继续进行AS治疗,并对部分患者进行减量化治疗。
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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
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