Active Surveillance for Screen-detected Low- and Intermediate-risk Prostate Cancer: Extended Follow-up up to 25 Years in the GÖTEBORG-1 Trial

IF 25.2 1区医学 Q1 UROLOGY & NEPHROLOGY

European urology Pub Date : 2025-06-25 DOI:10.1016/j.eururo.2025.06.012

Emmeli Palmstedt, Marianne Månsson, Jonas Hugosson, Rebecka Arnsrud Godtman

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Abstract

Background and objective

Active surveillance (AS) is used to postpone or avoid surgery or radiotherapy for prostate cancer (PC). While the risk of PC-related death remains low for patients deferring treatment, follow-up data have previously been limited to 15 yr. Since many men outlive this timeframe, studying long-term outcomes is crucial.

Methods

We included 488 men with screen-detected PC in the GÖTEBORG-1 screening trial managed with AS, of whom 251 were at a very low risk, 129 at a low risk, and 108 at an intermediate risk. Prostate-specific antigen (PSA) testing was performed every 6–12 mo, and repeated biopsies were indicated if there were signs of clinical progression. Treatment was recommended upon progression (PSA, grade, or stage). Kaplan-Meier analyses were performed for treatment-free, failure-free, and PC-specific survival, measuring time from diagnosis to an event or the last follow-up.

Key findings and limitations

During a median follow-up of 18 yr, a total of 232 men discontinued AS, 81 experienced failure, and 14 died from PC. The treatment-free survival rate at 22 yr was 38% for the entire cohort . At 19 yr, treatment-free survival rates were 55% for very-low-risk, 35% for low-risk, and 30% for intermediate-risk PC. The failure-free survival rate at 22 yr for all men was 68%, and at 19 yr, the rates were 85% for very-low-risk, 74% for low-risk, and 55% for intermediate-risk cases. The PC-specific survival rate at 25 yr for the entire cohort was 94%. At 24 yr, these rates were 99% for very-low-risk, 92% for low-risk, and 85% for intermediate-risk PC. The overall survival rate at 25 yr for all men was 32%, and at 24 yr, the rates were 38% for very-low-risk, 34% for low-risk, and 22% for intermediate-risk PC. The limitation was no predefined AS protocol.

Conclusions and clinical implications

This study confirms a low risk of PC death with a median follow-up of 18 yr. The risk of failure increased over time, highlighting the need for life-long monitoring. Providing men information about this risk is important.

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主动监测筛查发现的低危和中危前列腺癌：GÖTEBORG-1试验延长随访长达25年

背景与目的主动监测（AS）被用于推迟或避免前列腺癌（PC）的手术或放疗。虽然延迟治疗的患者与pc相关的死亡风险仍然很低，但随访数据以前仅限于15年。由于许多男性活过了这个时间范围，研究长期结果至关重要。方法我们纳入了488名筛查检测到PC的男性，其中251人处于极低风险，129人处于低风险，108人处于中等风险。每6-12个月进行一次前列腺特异性抗原（PSA）检测，如果有临床进展迹象，应重复活检。根据病情进展（PSA、分级或分期）推荐治疗。Kaplan-Meier分析对无治疗、无失败和pc特异性生存进行分析，测量从诊断到事件或最后随访的时间。主要发现和局限性：在中位18年的随访期间，共有232名男性停止了AS治疗，81人失败，14人死于PC。整个队列22年无治疗生存率为38%。19年时，极低风险PC的无治疗生存率为55%，低风险PC为35%，中风险PC为30%。22岁时，所有男性的无失败生存率为68%，19岁时，极低风险病例的无失败生存率为85%，低风险病例为74%，中风险病例为55%。整个队列25年的pc特异性生存率为94%。在24年时，极低风险PC的发生率为99%，低风险PC为92%，中等风险PC为85%。所有男性25岁时的总生存率为32%，24岁时，极低风险PC的生存率为38%，低风险PC的生存率为34%，中风险PC的生存率为22%。限制是没有预定义的AS协议。结论和临床意义本研究证实，中位随访18年的PC死亡风险较低，失败的风险随着时间的推移而增加，强调了终身监测的必要性。向男性提供有关这种风险的信息是很重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European urology 医学-泌尿学与肾脏学

CiteScore

43.00

自引率

2.60%

发文量

1753

审稿时长

23 days

期刊介绍： European Urology is a peer-reviewed journal that publishes original articles and reviews on a broad spectrum of urological issues. Covering topics such as oncology, impotence, infertility, pediatrics, lithiasis and endourology, the journal also highlights recent advances in techniques, instrumentation, surgery, and pediatric urology. This comprehensive approach provides readers with an in-depth guide to international developments in urology.