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首页> 外文期刊>BJU international >Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically.
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Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically.

机译：低危前列腺癌患者的最终结局适合主动监测，但需要手术治疗。

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OBJECTIVE: To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series. PATIENTS AND METHODS: From 1080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level <10 ng/mL, clinical stage < or =T2a and biopsy Gleason score < or =6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of 'insignificant' disease were assessed. RESULTS: The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1-9) ng/mL; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score > or =7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%) and biochemical failure occurred in six patients (1.1%) with a median follow-up of 28 months. CONCLUSION: In this contemporary UK cohort of patients with apparently low- or favourable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harbouring more significant disease.
机译：目的：研究来自英国各地的低危前列腺癌患者的当代队列研究结果，该研究结果符合英国国家健康与临床卓越研究所主动监测但经腹腔镜根治性前列腺切除术（LRP）治疗的患者一个外科医生系列。患者与方法：在2000年3月至2008年4月之间连续进行LRP的1080例患者中，有549例（51％）的患者术前低危疾病（PSA水平<10 ng / mL，临床分期<或= T2a和活检格里森评分<或= 6）。评估了这549例患者以及74例术前预测为“无关紧要”疾病的患者的病理结果。结果：患者的平均年龄为61岁，平均PSA水平（范围）为6.1（1-9）ng / mL。 38％的患者分期为cT2a。共有126例患者（23％）在最终病理学上升级为Gleason评分>或= 7。共有29例患者（5％）前列腺肥大并有精囊侵犯，其中5例（0.9％）。在74例术前预测为轻度疾病的患者中，有61％患有严重疾病，其中16％升为中危组。总体而言，有44名患者（8.0％）的切缘阳性，有6名患者（1.1％）发生了生化衰竭，平均随访28个月。结论：在这个当代英国人群中，这些患者明显患有低危或有利风险的前列腺癌，其中23％的疾病分级高于术前预测。尽管越来越多地建议采用主动监测来治疗低危局限性前列腺癌，但患者及其医生仍需要意识到藏有更重大疾病的潜力。

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