对于前列腺癌 (PCa) 主动监测 (AS) 期间监测的降级尚未达成共识。我们的目标是确定可用于决策以减少 AS 监测强度的临床标准。对来自全球行动计划前列腺癌 AS 联盟的全球前瞻性 AS 队列进行了回顾性分析。考虑了 24656 名具有完整结果数据的患者。主要目标是开发一个模型，识别其他原因死亡率 (OCM) 与 PCa 特异性死亡率 (PCSM) 比率较高的亚组。非参数竞争风险模型用于估计特定原因死亡率。我们假设 OCM/PCSM 比率最高的亚组将是 AS 监测降级的良好候选者。15 年累积死亡率（考虑到审查）PCSM 为 1.3%，OCM 为 11.5%，死亡为 18.7%出于未知原因。我们将初始活检时的体重指数 (BMI) >25 kg/m2 和 <11% 阳性核心确定为区分 OCM 和 PCSM 的最佳标准。符合这些标准的患者的 15 年 OCM/PCSM 比率比不符合标准的患者高 34.2 倍。根据这些标准，37% 的人群有资格接受降级监测。局限性包括该研究的回顾性和缺乏外部验证。我们的研究确定 BMI >25 kg/m2 和初始活检时阳性核心 <11% 作为 PCa 中 AS 监测降级的临床标准。我们调查了以下因素：可以帮助决定何时减少对前列腺癌主动监测患者的监测强度。我们发现，BMI（体重指数）较高且前列腺癌体积较小的患者可能是进行强度较低监测的良好候选者。该模型可以帮助医生和患者做出前列腺癌主动监测的决策。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.