The Emerging Role of Biomarkers to Improve Active Surveillance for Low-Risk Prostate Cancer

摘要

Active surveillance is increasingly recognized as a standard option-and in many cases the preferred option-for many of the tens-of-thousands of men diagnosed each year with clinically low-risk prostate cancer. Evidence to date, gathered primarily from academic centers, indicates a low risk of clinically meaningful disease progression with short- to intermediate-term follow up, and men opting for surveillance can avoid the potential adverse effects of surgery, radiation, and other treatments. However, surveillance as it is currently practiced is not without its drawbacks, and the number of men who ultimately will miss a window of opportunity for cure during a period of surveillance, while very low, is not zero. Current surveillance protocols are associated with direct risks. For example, serial prostate biopsies are associated with risks of significant infection and other adverse effects. There is a clear need for improvements to surveillance strategies that can early identify seemingly low-risk cancers that will in fact progress quickly without treatment and, conversely, strategies to identify those tumors that are are so indolent they can safely reduce their intensity of surveillance.