Altwein J E
Department of Urology, Hospital Barmherzige Brüder, Munich, Germany.
Eur Urol. 1999;35 Suppl 1:9-15; discussion 16.
Critical discussion of the available therapeutic options in locally defined or advanced prostate cancer (PCa) in the absence of standards or guidelines.
Medline-based survey of the pertinent literature. The therapeutic options are presented stage-by-stage.
Intracapsular PCa (T1a-T2bN0M0) is preferably managed by radical prostatectomy; 'insignificant' cancers may be treated expectantly. The outcome of irradiation is not as predictable as radical surgery. The following points regarding treatment of locally advanced PCa are still under debate: neoadjuvant treatment is probably not as efficient as believed; technical refinements of radical prostatectomy may be helpful; in some instances, the value of adjuvant treatment is undecided. The efficacy of irradiation in conjunction with androgen deprivation probably equals the efficacy of surgery. No consensus can be found in the presence of positive lymph nodes, although single institutions achieve remarkable results with surgery plus androgen deprivation.
Prognostic factors beside the clinical stages and grades should be incorporated in the treatment decision, and quality-of-life measurement should gain more importance when the treatment outcome is assessed.
在缺乏标准或指南的情况下，对局部明确或晚期前列腺癌（PCa）的现有治疗选择进行批判性讨论。
基于医学文献数据库（Medline）对相关文献进行检索。按阶段介绍治疗选择。
包膜内前列腺癌（T1a - T2bN0M0）最好通过根治性前列腺切除术治疗；“微小”癌可进行观察等待。放疗的结果不如根治性手术可预测。关于局部晚期前列腺癌的治疗，以下几点仍存在争议：新辅助治疗可能不如人们认为的有效；根治性前列腺切除术的技术改进可能有帮助；在某些情况下，辅助治疗的价值尚未确定。放疗联合雄激素剥夺的疗效可能与手术疗效相当。对于存在阳性淋巴结的情况，尚未达成共识，尽管个别机构采用手术加雄激素剥夺取得了显著效果。
治疗决策应纳入除临床分期和分级之外的预后因素，在评估治疗结果时，生活质量测量应得到更多重视。
