הסיכונים במעקב פעיל מחקר

הובא מחקר חדש שלכאורה מראה שהסיכון במעקב פעיל גדול ממה שחשבו. אבל ההסבר לא ברור לגמרי, בעיקר שהוא כביכול מבטל הרבה התניות שעקשורות למאובחנים- מטופלים. תוצאות המחקר פרסמו, האם הן באמת מעידות על סיכון גדול מחשבו במעקב פעיל. ולמי? למי שאובחן מן ההתחלה עם סיכוי לסרטן גרורתי ובכל זאת לא טופל או לכולם, כל מי שנמצא בביופסיה עם נגע סרטני?, זה לא מובן לי מהמאמר. אודה לעזרתך. התוצאה ציטוט : RESULTS Follow-up was complete for 1610 patients (98%). A risk-stratification analysis showed that more than one third of the men had intermediate or high-risk disease at diagnosis. Death from prostate cancer occurred in 45 men (2.7%): 17 (3.1%) in the active-monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group (P=0.53 for the overall comparison). Death from any cause occurred in 356 men (21.7%), with similar numbers in all three groups. Metastases developed in 51 men (9.4%) in the active-monitoring group, in 26 (4.7%) in the prostatectomy group, and in 27 (5.0%) in the radiotherapy group. Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively; clinical progression occurred in 141 men (25.9%), 58 (10.5%), and 60 (11.0%), respectively. In the active-monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. No differential effects on cancer-specific mortality were noted in relation to the baseline PSA level, tumor stage or grade, or risk-stratification score. No treatment complications were reported after the 10-year analysis. CONCLUSIONS After 15 years of follow-up, prostate cancer–specific mortality was low regardless of the treatment assigned. Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer. (Funded by the National Institute for Health and Care Research; ProtecT Current Controlled Trials number, ISRCTN20141297. opens in new tab; ClinicalTrials.gov number, NCT02044172. opens in new tab.) לינק למחקר תמצית. https://www.nejm.org/doi/full/10.1056/NEJMoa2214122