Aggressive treatment of low grade prostate cancer is unnecessary
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《英国医生杂志》
Aggressive treatment of localised low grade prostate cancer is inappropriate, a study has found. The long term study shows a very small risk of progression over 20 years of follow-up in patients treated conservatively ( JAMA 2005;293: 2095-101).
Peter Albertsen and colleagues analysed data from the Connecticut tumour registry, supplemented by hospital record and histology review, for 767 men aged 55 to 74 years diagnosed as having clinically localised prostate cancer between 1 January 1971 and 31 December 1984. All patients were treated conservatively with either observation or immediate or delayed androgen withdrawal therapy, with an average observation period of 24 years.
The results showed that men with low grade prostate cancer (a Gleason score of 2-4) had a small risk of prostate cancer progression, even after 20 years of management by observation or androgen withdrawal therapy alone. Their risk of dying from prostate cancer was only 6 (95% confidence interval 2 to 11) deaths per 1000 person years.
In contrast, men with poorly differentiated disease (Gleason scores of 7-10) had a high risk of death from prostate cancer within 10 years of diagnosis—121 (90 to 156) deaths per 1000 person years—only three men in this group were alive after 20 years.
Men with moderate grade disease (Gleason scores of 5-6) had an intermediate cumulative risk of prostate cancer progression after 20 years of follow-up.
Overall, prostate cancer mortality in the first 15 years of followup was 33 (28 to 38) per 1000 person years and after 15 years of follow-up was 18 (10-29) per 1000 person years. The mortalities for these two follow-up periods were not statistically different after adjusting for differences in tumour histology (ratio 1.1; 95% confidence interval 0.6 to 1.9).
Dr Albertsen, professor and chief of urology at the University of Connecticut Health Center, Farmington, United States, said, "Extended follow-up of our competing risk analysis suggests that prostate cancer progression rates do not increase after 15 years of follow-up.
"Men with low grade prostate cancer have only a small risk of prostate cancer progression... These results do not support aggressive treatment of localised low grade prostate cancer."
He said that, in fact, the data had probably overestimated progression in men treated by observation or androgen withdrawal therapy alone.(Susan Mayor)
Peter Albertsen and colleagues analysed data from the Connecticut tumour registry, supplemented by hospital record and histology review, for 767 men aged 55 to 74 years diagnosed as having clinically localised prostate cancer between 1 January 1971 and 31 December 1984. All patients were treated conservatively with either observation or immediate or delayed androgen withdrawal therapy, with an average observation period of 24 years.
The results showed that men with low grade prostate cancer (a Gleason score of 2-4) had a small risk of prostate cancer progression, even after 20 years of management by observation or androgen withdrawal therapy alone. Their risk of dying from prostate cancer was only 6 (95% confidence interval 2 to 11) deaths per 1000 person years.
In contrast, men with poorly differentiated disease (Gleason scores of 7-10) had a high risk of death from prostate cancer within 10 years of diagnosis—121 (90 to 156) deaths per 1000 person years—only three men in this group were alive after 20 years.
Men with moderate grade disease (Gleason scores of 5-6) had an intermediate cumulative risk of prostate cancer progression after 20 years of follow-up.
Overall, prostate cancer mortality in the first 15 years of followup was 33 (28 to 38) per 1000 person years and after 15 years of follow-up was 18 (10-29) per 1000 person years. The mortalities for these two follow-up periods were not statistically different after adjusting for differences in tumour histology (ratio 1.1; 95% confidence interval 0.6 to 1.9).
Dr Albertsen, professor and chief of urology at the University of Connecticut Health Center, Farmington, United States, said, "Extended follow-up of our competing risk analysis suggests that prostate cancer progression rates do not increase after 15 years of follow-up.
"Men with low grade prostate cancer have only a small risk of prostate cancer progression... These results do not support aggressive treatment of localised low grade prostate cancer."
He said that, in fact, the data had probably overestimated progression in men treated by observation or androgen withdrawal therapy alone.(Susan Mayor)