摘要：前列腺癌是男性常见癌症之一。在世界范围内，超过半数以上的新发前列腺癌病例为 Gleason评分 3+3=6 （GS6） 的低级别前列腺癌。绝大多数 GS6前列腺癌预后良好，极少出现远处转移，国际上首选的治疗和管理方 法为主动监测。近年来，泌尿外科领域部分学者基于 GS6前列腺癌发生的普遍性、极低的转移率、极佳的预后、 接近于癌前病变的筛查方式和治疗管理模式，认为其不应再被称为癌症，将其更名为非癌症可以缓解患者的焦虑 情绪，减少因过度治疗带来的毒副作用和经济负担。另有学者提出反对的观点，认为是否会出现转移，不应作为 判断肿瘤是否为恶性的唯一标准；在临床实践中，GS6前列腺癌患者存在术后病理升级的可能，应该综合多种临 床因素来判定肿瘤的性质和危险程度；此外，对GS6前列腺癌的更名可能造成患者的依从性降低，所以不应该对 其进行重新命名。本文对近期相关观点和论据进行总结，并对管理策略进行综述。

暂无相关信息！

[1] Erratum: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2020, 70(4): 313.

[2] The American Cancer Society medical and editorial content team. Survival Rates for Prostate Cancer [EB/OL]. https://www.cancer.org/cancer/prostate- cancer/detection- diagnosisstaging/survival-rates.html. 2022-03-01/2022-10-05.

[3] Belpomme D, Irigaray P. Re: Prostate cancer diagnosis and treatment after the introduction of prostate- specific antigen screening: 1986- 2005 [J]. Natl Cancer Inst, 2010, 102(7): 506-507.

[4] SEER. Cancer of the Prostate—Cancer Stat Facts [EB/OL]. https://seer.cancer.gov/statfacts/html/prost.html. 2022- 10- 05.

[5] Islami F, Ward EM, Sung H, et al. Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics [J]. J Natl Cancer Inst, 2021, 113(12): 1648-1669.

[6] Carter HB, Partin AW, Walsh PC, et al. Gleason score 6 adenocarcinoma: should it be labeled as cancer [J]. J ClinOncol, 2012, 30(35): 4294-4296.

[7] Belpomme D, Irigaray P. Re: Prostate cancer diagnosis and treatment after the introduction of prostate- specific antigen screening: 1986-2005 [J]. J Natl Cancer Inst, 2010, 102(7):506-507.

[8] Anderson BB, Oberlin DT, Razmaria AA, et al. Extraprostatic Extension Is Extremely Rare for Contemporary Gleason Score 6 Prostate Cancer [J]. Eur Urol, 2017, 72(3): 455-460.

[9] Ross HM, Kryvenko ON, Cowan JE, et al. Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes [J]. Am J Surg Pathol, 2012, 36(9): 1346-1352.

[10] Eggener SE, Scardino PT, Walsh PC, et al. Predicting 15- year prostate cancer specific mortality after radical prostatectomy [J]. J Urol, 2011, 185(3): 869-875.

[11] Eggener SE, Berlin A, Vickers AJ, et al. Low- Grade Prostate Cancer: Time to Stop Calling It Cancer [J]. J Clin Oncol, 2022, 40(27): 3110-3114.

[12] Donin NM, Laze J, Zhou M, et al. Gleason 6 prostate tumors diagnosed in the PSA era do not demonstrate the capacity for metastatic spread at the time of radical prostatectomy [J]. Urology, 2013, 82(1): 148-152.

[13] Kweldam CF, Wildhagen MF, Bangma CH, et al. Disease- specific death and metastasis do not occur in patients with Gleason score ≤6 at radical prostatectomy [J]. BJU Int, 2015, 116(2): 230-235.

[14] Eklund M, Jäderling F, Discacciati A, et al. MRI- Targeted or Standard Biopsy in Prostate Cancer Screening [J]. N Engl J Med, 2021 Sep 2, 385(10):908-920.

[15] Kasivisvanathan V, Rannikko AS, Borghi M, et al. PRECISION Study Group Collaborators. MRI- Targeted or Standard Biopsy for Prostate- Cancer Diagnosis [J]. N Engl J Med, 2018, 378(19): 1767-1777.

[16] Narayan VM. A critical appraisal of biomarkers in prostate cancer [J]. World J Urol, 2020, 38(3): 547-554.

[17] Chen RC, Rumble RB, Jain S. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement Summary [J]. J Oncol Pract, 2016, 12(3): 267-269.

[18] Klotz L, Vesprini D, Sethukavalan P, et al. Long- term follow- up of a large active surveillance cohort of patients with prostate cancer [J]. J Clin Oncol, 2015, 33(3): 272-277.

[19] Tosoian JJ, M amawala M, Epstein JI, et al. Active Surveillance of Grade Group 1 Prostate Cancer: Long-term Outcomes from a Large Prospective Cohort [J]. Eur Urol, 2020, 77(6): 675-682.

[20] Wilt TJ, Jones KM, Barry M J, et al. Follow- up of Prostatectomy versus Observation for Early P rostate Cancer [J]. N Engl J Med, 2017, 377(2): 132-142.

[21] Hamdy FC, Donovan JL, Lane JA, et al. 10- Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer [J]. N Engl J Med, 2016, 375(15): 1415-1424.

[22] Kwaan MR, Fan Y, Jarosek S, et al. Long- term Risk of Urinary Adverse Events in Curatively Treated Patients With Rectal Cancer: A Population- Based Analysis [J]. DisColon Rectum, 2017, 60(7): 682-690.

[23] Loeb S, Folkvaljon Y, Curnyn C, et al. Uptake of active surveillance for very- low- risk prostate cancer in Sweden [J]. JAMA Oncology, 2017, 3(10): 1393-1398.

[24] Timilshina N, Ouellet V, Alibhai SM, et al. Analysis of active surveillance uptake for low- risk localized prostate cancer in Canada: a Canadian multi- institutional study [J]. World J Urol, 2017, 35(4): 595-603.

[25] Loeb S, Byrne NK, Wang B, et al. Exploring Variation in the Use of Conservative Management for Low- risk Prostate Cancer in the Veterans Affairs Healthcare System [J]. Eur Urol, 2020, 77(6): 683-686.

[26] Epstein JI, Allsbrook WC Jr, Amin MB, et al. ISUP G rading Committee. The 2005 International Society of U rological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma [J]. Am J Surg Pathol, 2005, 29(9): 1228-1242.

[27] Miyamoto H, Miller JS, Fajardo DA, et al. Non-invasive papillary urothelial neoplasm s: the 2004 WHO/ISUP classification system [J]. Pathol Int, 2010, 60(1): 1-8.

[28] Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors [J]. JAMA Oncol, 2016, 2(8): 1023-1029.

[29] Omer ZB, Hwang ES, Esserman LJ, et al. Impact of ductal carcinoma in situ terminology on patient treatment preferences [J]. JAMA Intern Med, 2013, 173(19): 1830-1831.

[30] Welch HG, Mazer BL, Adamson AS. The Rapid Rise in Cutaneous Melanoma Diagnoses [J]. N Engl J Med, 2021, 384(1): 72-79.

[31] Trogdon JG, Falchook AD, Basak R, et al. Total Medicare Costs Associated With Diagnosis and Treatment of Prostate Cancer in Elderly Men [J]. JAMA Oncol, 2019, 5(1): 60-66.

[32] Carlsson S, Sandin F, Fall K, et al. Risk of suicide in men with low- risk prostate cancer [J]. Eur J Cancer, 2013, 49(7):1588-1599.

[33] Epstein JI, Kibel AS. Renaming Gleason Score 6 Prostate to Noncancer: A Flawed Idea Scientifically and for Patient Care [J]. J Clin Oncol, 2022, 40(27): 3106-3109.

[34] Hao X, Billings SD, Wu F, et al. Dermatofibrosarcoma Protuberans: Update on the Diagnosis and Treatment [J]. JClin Med, 2020, 9(6): 1752.

[35] Epstein JI, Feng Z, Trock BJ, et al. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades [J]. Eur Urol, 2012, 61(5): 1019-1024.

[36] H assan O, H an M , Z hou A, e t al. Incidence of Extraprostatic Extension at Radical Prostatectomy with Pure Gleason Score 3 + 3=6 (Grade Group 1) Cancer: Implications for Whether Gleason Score 6 Prostate Cancer Should be Renamed“Not Cancer”and for Selection Criteria for Active Surveillance [J]. J Urol, 2018, 199(6): 1482-1487.

[37] Pettersson A, Graff RE, Bauer SR, et al. The TMPRSS2: ERG rearrangement, ERG expression, and prostate cancer outcomes: a cohort study and meta- analysis [J]. Cancer Epidemiol Biomarkers Prev, 2012, 21(9): 1497-1509.

[38] Baca SC, Prandi D, Law rence MS, et al. Punctuated evolution of prostate cancer genomes [J]. Cell, 2013, 153(3): 666-677.

[39] Barbieri CE, Baca SC, Law rence MS, et al. Exome sequencing identifies recurrent SPOP, FOXA1 and MED12 mutations in prostate cancer [J]. Nat Genet. 2012, 44(6): 685-689.

[40] Nakayama M, Gonzalgo ML, Yegnasubramanian S, et al. GSTP1 CpG island hypermethylation as a m olecular biomarker for prostate cancer [J]. J Cell Biochem, 2004,91(3): 540-552.

[41] Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options [J]. J Urol, 2018, 199(4): 990-997.

[42] Carter HB, Helfand B, Mamawala M, et al. Germline Mutations in ATM and BRCA1/2 Are Associated with Grade Reclassification in Men on Active Surveillance for Prostate Cancer [J]. Eur Urol, 2019, 75(5): 743-749.

[43] S tavrinides V, Giganti F, T rock B, et al. Five- year Outcomes of Magnetic Resonance Imaging- based Active Surveillance for Prostate Cancer: A Large Cohort Study [J]. Eur Urol, 2020, 78(3): 443-451.

[44] Krishna S, Fan Y, Jarosek S, et al. Racial Disparities in Active Surveillance for Prostate Cancer [J]. J Urol, 2017,197(2): 342-349.

[45] Lane JA, Donovan JL, Young GJ, et al. Functional and quality of life outcomes of localise d prostatecancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study) [J]. BJU Int, 2022, 130(3): 370-380.

[46] Hoffman RM, Mott SL, McDowell BD, et al. Trends and practices for managing low- risk prostate cancer: a SEER- Medicare study [J]. Prostate Cancer Prostatic Dis, 2022, 25(1): 100-108.

[47] Cooperberg MR, Carroll PR. Trends in Management for Patients With Localized Prostate Cancer, 1990- 2013 [J]. JAMA, 2015, 314(1): 80-82.

[48] O ng W L, E vans SM , E vans M , e t al. T rends inConservative Management for Low- risk Prostate Cancer in a P opulation- based C oho r t of A us tralian M en Diagnosed Between 2009 and 2016 [J]. Eur Urol Oncol, 2021, 4(2): 319-322.

[49] Liu J, Dong L, Zhu Y, et al. Prostate cancer treatmentChina’s perspective [J]. Cancer Lett, 2022, 550: 215927.

马金铎,曹煜东,王硕,等.Gleason 评分 3+3 前列腺癌的命名争议及管理策略[J]. 泌尿外科杂志（电子版）,2022,14(4):9-14. DOI:10.20020/j.CNKI.1674-7410.2022.04.03

暂无相关信息！

根据 GLOBOCAN 2020 数据显示，全球范围 内前列腺癌的发病率位列男性恶性肿瘤的第 2 位[1] 。 虽然前列腺癌的发病率较高，但相比于多数恶性肿瘤，其预后相对较好。根据美国癌症协会的数据显 示，美国前列腺癌患者总体 5年生存率约为 98%，其 中局限期前列腺癌患者的 5年生存率超过 99%；转移 性前列腺癌患者的 5 年生存率约为 31%[2] 。研究表 明，在美国仅 3%的前列腺癌患者最终死于该疾病。 一方面是近 30年医学技术水平的发展使前列腺癌的 治疗手段更加先进，另一方面是前列腺癌通常呈惰 性生长，发展相对较慢，而大量的以前列腺特异性 抗原 （prostate specific antigen，PSA） 为主的前列 腺癌筛查导致许多早期低危的前列腺癌，即无临 床 显著意义的前列腺癌 （non- clinically significant prostate cancer，ncsPCa） 被检出。这些早期低危 的前列腺癌往往进展缓慢，极少出现转移并导致患 者 死亡。近年来，有学者认为对于低级别前列腺 癌 （Gleason Score3+3=6，GS6） 应被重新命名， 不再称之为“癌症”，而以美国约翰霍普金斯医院病 理学专家 Jonathan I. Epstein （J.I.E） 为代表的学者 则持相反观点，认为将 GS6前列腺癌重命名为非癌 症是不科学的。本文对目前学界相关观点和论据进 行整理，并对该病的管理策略加以综述。

1 正方观点：GS6 前列腺癌应该重新命名，不应再 被称为癌症

2 反方观点：GS6 前列腺癌不应重新命名

3 AS 是 GS6 前列腺癌的治疗标准

总而言之，随着我国如今检测手段技术水平的 提高、对于该疾病理解的愈发深入以及当今对前列 腺癌筛查和普及的增强，不可避免的使我们对于 GS6 前列腺癌的检出率有所提高。笔者认为，对于 GS6 前列腺癌关注重点应该更多的放在如何精准识 别这些患者以及如何管理的问题上。

暂无相关信息！

暂无相关信息！