本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.6695

摘要内容如下：

重要性

需要方案指导的有利风险前列腺癌主动监测的结果来支持决策。

目的

描述在多中心、方案指导队列中接受主动监测的患者的长期肿瘤学结果。

设计、设置和参与者

金丝雀前列腺主动监测研究（PASS）是一项于2008年启动的前瞻性队列研究。截至2022年8月，在10个北美中心招募了2155名患有有利风险前列腺癌且既往未接受治疗的男性。

曝光

前列腺癌的主动监测。

主要成果和措施

在首次或后续监测活检后接受治疗的患者中，活检级别重新分类、治疗、转移、前列腺癌死亡率、总死亡率和治疗后复发的累积发生率。

结果

在2155例局限性前列腺癌患者中，中位随访时间为7.2年，中位年龄为63岁，83%为白人，7%为黑人，90%被诊断为1级癌症，前列腺特异性抗原（PSA）中位数为5.2 ng/mL。诊断10年后，活检重新分级和治疗的发生率分别为43%（95%CI，40%-45%）和49%（95%CI，47%-52%）。分别有425例和396例患者在确诊或随后的监测活检后接受治疗（诊断后中位时间分别为1.5年和4.6年），5年复发率分别为11%（95%CI，7%-15%）和8%（95%CI，5%-11%）。21名参与者进展为转移性癌症，3例前列腺癌相关死亡。诊断后10年估计的转移率或前列腺癌特异性死亡率分别为1.4%（95%CI，0.7%-2%）和0.1%（95%CI，0%-0.4%）；同期总死亡率为5.1%（95%CI，3.8%-6.4%）。

结论和相关性

在这项研究中，确诊10年后，49%的男性保持无进展或无治疗，不到2%的人发展为转移性疾病，不到1%的人死于他们的疾病。监测期间的后期进展和治疗与较差的预后无关。这些结果表明，对于诊断为有利风险前列腺癌的患者，主动监测是一种有效的管理策略。

英文原文如下：

Abstracts

Importance  Outcomes from protocol-directed active surveillance for favorable-risk prostate cancers are needed to support decision-making.

Objective  To characterize the long-term oncological outcomes of patients receiving active surveillance in a multicenter, protocol-directed cohort.

Design, Setting, and Participants  The Canary Prostate Active Surveillance Study (PASS) is a prospective cohort study initiated in 2008. A cohort of 2155 men with favorable-risk prostate cancer and no prior treatment were enrolled at 10 North American centers through August 2022.

Exposure  Active surveillance for prostate cancer.

Main Outcomes and Measures  Cumulative incidence of biopsy grade reclassification, treatment, metastasis, prostate cancer mortality, overall mortality, and recurrence after treatment in patients treated after the first or subsequent surveillance biopsies.

Results  Among 2155 patients with localized prostate cancer, the median follow-up was 7.2 years, median age was 63 years, 83% were White, 7% were Black, 90% were diagnosed with grade group 1 cancer, and median prostate-specific antigen (PSA) was 5.2 ng/mL. Ten years after diagnosis, the incidence of biopsy grade reclassification and treatment were 43% (95% CI, 40%-45%) and 49% (95% CI, 47%-52%), respectively. There were 425 and 396 patients treated after confirmatory or subsequent surveillance biopsies (median of 1.5 and 4.6 years after diagnosis, respectively) and the 5-year rates of recurrence were 11% (95% CI, 7%-15%) and 8% (95% CI, 5%-11%), respectively. Progression to metastatic cancer occurred in 21 participants and there were 3 prostate cancer-related deaths. The estimated rates of metastasis or prostate cancer-specific mortality at 10 years after diagnosis were 1.4% (95% CI, 0.7%-2%) and 0.1% (95% CI, 0%-0.4%), respectively; overall mortality in the same time period was 5.1% (95% CI, 3.8%-6.4%).

Conclusions and Relevance  In this study, 10 years after diagnosis, 49% of men remained free of progression or treatment, less than 2% developed metastatic disease, and less than 1% died of their disease. Later progression and treatment during surveillance were not associated with worse outcomes. These results demonstrate active surveillance as an effective management strategy for patients diagnosed with favorable-risk prostate cancer.

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