前列腺癌 (PCa) 的主动监测 (AS) 是低级别疾病的护理标准，但针对稳定患者制定治疗方案的指导有限。我们调查了没有初始进展的患者的长期结局和升级的危险因素。纳入了患有 AS 的男性，在 3 次连续活检中，≥5 年无进展，≥10 年随访，格里森分级组 (GG) 1 PCa 。结果包括升级（GG ≥2）、主要升级（GG ≥3）、治疗进展、转移、PCa 特异性生存率和总生存率。 Cox 比例风险回归模型用于估计患者特征与升级风险之间的关联。共有 774 名男性符合纳入标准。 10 年、12 年和 15 年时，免升级生存率分别为 56%、45% 和 21%；主要免升级生存率分别为 88%、83% 和 61%；无治疗生存率分别为 86%、83% 和 73%；无转移生存率分别为 99%、99% 和 98%；总生存率分别为 98%、96% 和 95%。 15 年时 PCa 特异性存活率为 100%。在多变量分析中，诊断年份、年龄、体重指数 (BMI) 和活检核心阳性与升级相关（所有 p < 0.01），而年龄和前列腺特异性抗原 (PSA) 密度与主要升级相关。 AS 5 年无进展的患者在 15 年的随访中升级率适中，转移率和死亡率较低。诊断年份、年龄较大、BMI增加和活检核心阳性率增加与升级相关，而年龄较大和PSA密度较高则与重大升级风险增加相关。这些患者中的一部分可能会受益于 AS 方案的去强化治疗。对于在主动监测 (AS) 中多年保持稳定的 PCa 患者，几乎没有报道数据或临床指南。我们在一个大型队列中表明，5 年 AS 未进展的 PCa 患者在 15 年随访中具有适度的升级率和非常低的转移率以及死亡率，并且年龄较大、体重指数增加，并且 PCa 数量的增加与未来升级的可能性增加相关。这项研究支持在该患者群体中继续进行 AS，并在选定的患者中进行去强化治疗。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。

Active surveillance (AS) of prostate cancer (PCa) is the standard of care for low-grade disease, but there is limited guidance on tailoring protocols for stable patients. We investigated long-term outcomes for patients without initial progression and risk factors for upgrade.Men on AS with Gleason grade group (GG) 1 PCa on three serial biopsies, ≥5 yr without progression, and ≥10 yr of follow-up were included. Outcomes were upgrade (GG ≥2), major upgrade (GG ≥3), progression to treatment, metastasis, PCa-specific survival, and overall survival. Cox proportional hazards regression models were used to estimate the associations between patient characteristics and risk of upgrade.A total of 774 men met the inclusion criteria. At 10, 12, and 15 yr, upgrade-free survival rates were 56%, 45%, and 21%; major upgrade-free survival rates were 88%, 83%, and 61%; treatment-free survival rates were 86%, 83%, and 73%; metastasis-free survival rates were 99%, 99%, and 98%; and overall survival rates were 98%, 96%, and 95%, respectively. PCa-specific survival was 100% at 15 yr. On a multivariable analysis, year of diagnosis, age, body mass index (BMI), and biopsy core positivity were associated with upgrade (all p < 0.01), whereas age and prostate-specific antigen (PSA) density were associated with major upgrade.Patients without progression for 5 yr on AS had modest rates of upgrade and low rates of metastasis, and mortality at 15 yr of follow-up. Year of diagnosis, older age, increased BMI, and increased biopsy core positivity were associated with upgrade, whereas older age and greater PSA density were associated with an increased risk of major upgrade. A subset of these patients may benefit from deintensification of AS protocols.There are little reported data or clinical guidelines for patients with PCa who are stable for many years on active surveillance (AS). We show, in a large cohort, that PCa patients without progression for 5 yr on AS have modest rates of upgrade and very low rates of metastasis, and mortality rates at 15 yr of follow-up, and that older age, increased body mass index, and increased PCa volume are associated with an increased likelihood of future upgrade. This study supports continued AS in this patient population and deintensification in select patients.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.