前列腺癌的主动监测

谁会受益

The ideal candidate for active surveillance has:

• A PSA at the time of diagnosis of 10 ng/mL or less that does not change much over time. A better way to interpret risk using PSA is to calculate PSA density, 或PSAD (PSA除以前列腺体积). PSA密度小于0.15 is favorable, suggesting the cancer is unlikely to grow.
• 超声波, 核磁共振成像, digital rectal exam or other test results suggesting the cancer has not spread outside the prostate gland.
• 活检结果显示是低风险癌症, including a Gleason score of 6 or less (no pattern 4 or 5). 然而, it is important that the biopsy was performed correctly, with enough samples taken to confirm that the cancer isn't large or aggressive. If the initial biopsy wasn't performed at a high-volume center and wasn't image-guided, another biopsy is usually warranted before finalizing a decision for active surveillance. These confirmatory biopsies are particularly important if the original biopsy was done outside an academic setting. An 核磁共振成像 is recommended before the biopsy to help target the tissues to sample.

Active surveillance may also be an option for some patients with slightly higher risk cancers (such as those with a low-volume Gleason score of 3+4), especially if imaging or genomic testing results are reassuring.

一些男性有危险因素, such as a family history of cancer and genetic mutations, may still choose active surveillance but may need a more intensive surveillance regimen to identify any early signs of disease progression. 非裔美国人, who seem to have an elevated risk for disease progression, 也可能需要更密切的监测.

会发生什么

如果你选择主动监视, you'll see your doctor for regular checkups. During these visits, you'll undergo tests to detect any changes in your cancer. 测试通常包括:

• A blood test every six months to measure PSA levels
• Genetic testing of the tumor and other tests that help assess risk and the appropriateness of continuing active surveillance
• Repeat 核磁共振成像 scans or 前列腺活检 (or both) every one to two years initially (sometimes sooner than one year) and then less frequently to monitor your cancer grade and volume

If the tests suggest your cancer is growing or becoming more aggressive, 你的十大赌博平台排行榜可能会建议你接受治疗, 比如手术或放射治疗, 或者提前你下次活检的时间. 但如果变化很小或根本不存在, your doctor may advise that you can safely continue active surveillance.

作为治疗的一部分, you doctor may also recommend lifestyle changes, 比如改善你的营养, 减轻压力，多锻炼. A UCSF study showed that patients on active surveillance who made lifestyle changes had lower PSA levels and lower treatment rates than those who didn't make these changes. You may find it helpful to join a support group or participate in a study on the impact of nutrition, 锻炼和其他生活方式因素. Consistently making healthy choices can also lower your risk of cardiovascular disease – the number one cause of death in men with or without prostate cancer.

风险

There are some risks associated with active surveillance. They include a low risk of infection with every biopsy and a very low risk of cancer progressing in any one interval of surveillance. Sometimes men choose active surveillance for a period of time and then decide to undergo treatment.

Thousands of UCSF patients have chosen active surveillance to initially manage their prostate cancer. This is one of the largest groups of patients on active surveillance in the world. About one-third of these men receive treatments, 比如手术或放疗, within five years of diagnosis and 50% within 10 years. The window of opportunity to cure a prostate cancer is usually years or even decades. Outcomes for men who choose active surveillance after diagnosis are similar to the expected outcomes if they had chosen surgery or radiation right away. Based on our experience and data from other centers, the risk of significant cancer progression in the short to intermediate term, 而不是零, 看起来很低.

Your doctor can answer any questions you have about active surveillance. Together, you can decide whether this is a good option for you.