BACKGROUND Utilization of active surveillance (AS) for prostate cancer is increasing. Optimal selection criteria for this approach are undefined and questions remain on how best to expand inclusion beyond typical men with very low- or low-risk disease. We sought to review the current experience with AS for men with intermediate-risk featuresMethods:PubMed was queried for all relevant original publications describing outcomes for men with prostate cancer managed with AS. Outcomes for patients with intermediate-risk features as defined by the primary investigators were studied when available and compared with similar risk men undergoing immediate treatment. RESULTS Cancer-specific survival for men managed initially with AS is similar to results published with immediate radical intervention. A total of five published AS series describe some outcomes for men with intermediate-risk features. Definitions of intermediate risk vary between studies. Men with Gleason 7 disease experience higher rates of clinical progression and are more likely to undergo treatment over time. Intermediate-risk men with Gleason 6 disease have similar outcomes to low-risk men. Men with Gleason 7 disease appear at higher risk for metastatic disease. Novel technologies including imaging and biomarkers may assist with patient selection and disease surveillance. CONCLUSIONS The contemporary experiences of AS for men with intermediate-risk features suggest that although these men are at higher risk for eventual prostate-directed treatment, some are not significantly compromising chances for longer-term cure. Men with more than minimal Gleason pattern 4, however, must be carefully selected and surveyed for early signs of progression and may be at increased risk of metastases. Incorporating information from advanced imaging and biomarker technology will likely individualize future treatment decisions while improving overall surveillance strategies.

中文翻译：

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积极监测中危前列腺癌。

背景技术对于前列腺癌的主动监视（AS）的使用正在增加。这种方法的最佳选择标准尚未确定，如何将包容性扩展到极低或低风险的典型男性之外仍存在疑问。我们试图回顾一下具有中等风险特征的男性的AS的当前使用方法方法：请向PubMed查询所有相关的原始出版物，这些出版物描述了用AS治疗的前列腺癌男性的结局。根据主要研究者的定义，研究具有中等风险特征的患者的预后，并与接受立即治疗的类似风险患者进行比较。结果最初接受AS治疗的男性的癌症特异性生存率与立即进行彻底干预所发表的结果相似。共有五个已出版的AS系列描述了具有中危特征的男性的一些结局。中间风险的定义因研究而异。格里森7病患者的临床进展率较高，并且随着时间的推移接受治疗的可能性更高。患有格里森6病的中危男性与低危男性的结局相似。患有格里森7病的男性出现转移性疾病的风险更高。包括成像和生物标志物在内的新技术可能有助于患者选择和疾病监测。结论具有中等风险特征的男性的AS的现代经验表明，尽管这些男性最终接受前列腺定向治疗的风险较高，但其中一些并不能显着降低长期治愈的机会。格里森模式不止于极少数的男人4 必须仔细选择和调查其进展的早期迹象，并且可能增加转移的风险。整合来自先进成像和生物标记技术的信息可能会个性化将来的治疗决策，同时改善整体监测策略。