据9月16日刊JAMA上的一则研究披露，对在不同时期被诊断的局灶性前列腺癌的保守疗法的结果进行比较后发现，与那些在1970年代至1980年代被诊断的人相比，那些在1992-2002年期间被诊断的患者的总体存活率及前列腺癌特异性存活率都有所提高。
根据文章的背景资料：“在男性中，前列腺癌是除皮肤癌之外的最常见的癌症，它也是美国第二位最常见的癌症死亡原因。当被诊断的时候，大约有85%的前列腺癌是局限在前列腺内的，而对其的标准治疗选项通常包括外科手术、放疗或保守处理（即积极监控或将治疗时间延迟到有必要对疾病的症状和体征进行治疗的时候）。” “但是，尽管保守疗法是一种可能的合理治疗选择，但仅有大约10%的病人接受了保守疗法，这也许是因为人们对其的了解以及当代的有关这种疗法的预计进程和结果的数据有限所造成的。” 文章的作者补充说，由于缺乏可靠的当代资讯使得患者以及他们的医生对结果的预计以及做出有见地的治疗决定变得困难。
Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School, Piscataway, N.J.的Grace L. Lu-Yao, M.P.H., Ph.D.及其同僚分析了来自局灶性T1 或 T2前列腺癌患者的数据，并对保守处理局灶性前列腺癌的结果进行了评估，这些前列腺癌的诊断时期与前列腺特殊抗原（PSA）的时期是相同的。 这些基于人群的群组研究包括了其前列腺癌在诊断的时候（1992-2002 ）处于T1或T2期的1万4516名年龄在65岁或以上的男子，这些人的癌症在诊断之后的6个月之内没有接受过手术或放射治疗。 这些患者所居住的地区具有监控、流行病学和终末结果（SEER）的计划。对这些患者的追踪随访的中位（中点）数时间为8.3年（至2007年12月）。患者在诊断时的中位数年龄为78岁。
研究人员发现，前列腺特异性的10年死亡率在分化良好的患者中为8.3%；在中等分化的患者中为9.1%；在分化不良的患者中为25.6%。 这些患者组的相应的10年死于非前列腺癌的死亡率分别为59.8%、57.2%及56.5%。
“在其它各种因素中，与先前的报告相比，我们在研究中所观察到的患者存活率的显著改善可以由前置期的增加、与PSA测试有关的过度诊断或等级迁移而得到部分的解释。 前列腺特异性抗原测试可在该疾病出现临床症兆之前6-13年便可被发现。 由于有这个前置时间的存在，预计当代的通过这种测试所发现的患者至少要多活6-13年的时间。”(生物谷www.bioon.com)
Bioon推荐原始出处：
JAMA. 2009;302(11):1202-1209.
Outcomes of Localized Prostate Cancer Following Conservative Management
Grace L. Lu-Yao, MPH, PhD; Peter C. Albertsen, MD; Dirk F. Moore, PhD; Weichung Shih, PhD; Yong Lin, PhD; Robert S. DiPaola, MD; Michael J. Barry, MD; Anthony Zietman, MD; Michael O’Leary, MD, MPH; Elizabeth Walker-Corkery, MPH; Siu-Long Yao, MD
Context Most newly diagnosed prostate cancers are clinically localized, and major treatment options include surgery, radiation, or conservative management. Although conservative management can be a reasonable choice, there is little contemporary prostate-specific antigen (PSA)–era data on outcomes with this approach.
Objective To evaluate the outcomes of clinically localized prostate cancer managed without initial attempted curative therapy in the PSA era.
Design, Setting, and Participants A population-based cohort study of men aged 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median of 8.3 years (through December 31, 2007). Competing risk analyses were performed to assess outcomes.
Main Outcome Measures Ten-year overall survival, cancer-specific survival, and major cancer related interventions.
Results Among men who were a median age of 78 years at cancer diagnosis, 10-year prostate cancer-specific mortality was 8.3% (95% confidence interval [CI], 4.2%-12.8%) for men with well-differentiated tumors; 9.1% (95% CI, 8.3%-10.1%) for those with moderately differentiated tumors, and 25.6% (95% CI, 23.7%-28.3%) for those with poorly differentiated tumors. The corresponding 10-year risks of dying of competing causes were 59.8% (95% CI, 53.2%-67.8%), 57.2% (95% CI, 52.6%-63.9%), and 56.5% (95% CI, 53.6%-58.8%), respectively. Ten-year disease-specific mortality for men aged 66 to 74 years diagnosed with moderately differentiated disease was 60% to 74% lower than earlier studies: 6% (95% CI, 4%-8%) in the contemporary PSA era (1992-2002) compared with results of previous studies (15%-23%) in earlier eras (1949-1992). Improved survival was also observed in poorly differentiated disease. The use of chemotherapy (1.6%) or major interventions for spinal cord compression (0.9%) was uncommon.
Conclusions Results following conservative management of clinically localized prostate cancer diagnosed from 1992 through 2002 are better than outcomes among patients diagnosed in the 1970s and 1980s. This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care.
