The ongoing need for improved risk stratification and monitoring for those on active surveillance for early stage prostate cancer

摘要

With the recognition of the prevalence of clinically indolent prostate cancer (PCa), the goal of PCa care has shifted from detection and treatment of all men with PCa to identifying and treating only men with clinically significant disease, disease that would put them at risk if left undiagnosed. However, current risk stratification schemes are not perfect. The parameters traditionally used to stratify pretreatment PCa risk (e.g., prostate-specific antigen [PSA], Gleason score (GS), T stage, tumor volume) misclassify some patients [1,2]. As a result, current active surveillance (AS) protocols call for monitoring all patients, even those with very favorable disease characteristics, with serial PSAs, examination, selective use of imaging, and periodic prostate biopsy. However, such a strategy for all patients may neither be safe nor necessary. The potential morbidity and cost of repeat biopsy, as well as other repeated evaluations, is leading clinicians (and their patients) in search of new, more refined markers of risk and the need for eventual treatment.