主动监测 (AS) 已发展成为世界各地许多患有低风险前列腺癌（或在某些情况下为中等风险疾病）男性的广泛应用的治疗策略。在此，我们报告了 AS 的安全性和可接受性，以及对 14,623 名男性的低风险和中度风险肿瘤的治疗结果，随访时间超过 6 年。来自 25 个队列的 26,999 名 AS 男性的临床数据国际数据库中自 2000 年起收集了 15 个国家的数据。在我们预先定义的四个时间段（每个时间段为 4 年）（涵盖 2000 年至 2016 年）中，总生存期 (OS) 没有显着变化。然而，自第二阶段以来，无转移生存率 (MFS) 有所改善，并且非常好 (>99%)。早期的无治疗生存率显示，向根治性治疗的转变稍快一些。随着时间的推移，因焦虑而改变治疗方案的男性比例始终保持在 5%。然而，也有 10-15% 的人改变了治疗方法，但没有明显的原因。在一部分男性（10-15%）中，肿瘤进展是治疗的触发因素。在选择根治性治疗的男性中，手术是最常见的治疗方式。在那些接受根治性治疗的男性中，90% 的人在治疗后 5 年没有出现生化复发。我们的研究证实，在这个长期随访的大型多中心队列中，AS 在整个治疗期间是一种安全的治疗选择，因为10 年 OS 为 84.1%，MFS 为 99.4%。最初患有低风险肿瘤的男性在 10 岁时接受治疗的概率为 20%，而患有中风险肿瘤的男性则为 31%。新的诊断方式可以提高个体风险评估随访的可接受性，同时安全地扩大 AS 在高风险肿瘤中的使用。主动监测 (AS) 已发展成为许多前列腺癌男性广泛应用的治疗策略。世界。在这份报告中，我们展示了患有低风险和中风险前列腺癌的男性接受 AS 治疗的长期安全性。我们的研究证实 AS 是低风险和中风险前列腺癌的安全治疗选择。新的诊断方式可以提高使用个体风险评估进行随访的可接受性，同时安全地扩大 AS 在高风险肿瘤中的使用。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Active surveillance (AS) has evolved into a widely applied treatment strategy for many men around the world with low-risk prostate cancer (or in selected cases intermediate-risk disease). Here, we report on the safety and acceptability of AS, and treatment outcomes for low- and intermediate-risk tumours over time in 14 623 men with follow-up of over 6 yr.Clinical data from 26 999 men on AS from 25 cohorts in 15 countries have been collected in an international database from 2000 onwards.Across our predefined four time periods of 4 yr each (covering the period 2000-2016), there was no significant change in overall survival (OS). However, metastasis-free survival (MFS) rates have improved since the second period and were excellent (>99%). Treatment-free survival rates for earlier periods showed a slightly more rapid shift to radical treatment. Over time, there was a constant proportion of 5% of men for whom anxiety was registered as the reason for treatment alteration. There was, however, also a subset of 10-15% in whom treatment was changed, for which no apparent reason was available. In a subset of men (10-15%), tumour progression was the trigger for treatment. In men who opted for radical treatment, surgery was the most common treatment modality. In those men who underwent radical treatment, 90% were free from biochemical recurrence at 5 yr after treatment.Our study confirms that AS was a safe management option over the full duration in this large multicentre cohort with long-term follow-up, given the 84.1% OS and 99.4% MFS at 10 yr. The probability of treatment at 10 yr was 20% in men with initial low-risk tumours and 31% in men with intermediate-risk tumours. New diagnostic modalities may improve the acceptability of follow-up using individual risk assessments, while safely broadening the use of AS in higher-risk tumours.Active surveillance (AS) has evolved into a widely applied treatment strategy for many men with prostate cancer around the world. In this report, we show the long-term safety of following AS for men with low- and intermediate-risk prostate cancer. Our study confirms AS as a safe management option for low- and intermediate-risk prostate cancer. New diagnostic modalities may improve the acceptability of follow-up using individual risk assessments, while safely broadening the use of AS in higher-risk tumours.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.