Pisansky T M, Davis B J
Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Semin Urol Oncol. 2000 May;18(2):93-107.
The anatomic extent of prostate cancer has long served the role of providing prognostic information to assist in therapeutic decision-making, evaluating treatment outcomes, facilitating information exchange between medical centers, and promoting cancer research. However, nonanatomic factors are also associated with important pathological features of this condition and may be used to estimate therapeutic outcome. At present, tumor grade (eg, Gleason score) ascertained from the diagnostic biopsy specimen and the pretherapy serum prostate-specific antigen level are readily available in clinical practice. This information may be used along with clinical tumor stage to construct predictive models. These models may provide reliable estimates for the likelihood of extraprostatic tumor extension, seminal vesicle invasion, or pelvic lymph-node involvement. Consideration of this information may play a vital role in the selection of radiotherapeutic modality and in the definition of external beam radiotherapy treatment volumes. These same factors are also associated with disease relapse and may be combined in a fashion to estimate the prospects for cancer control in the individual patient and in homogeneous patient groups. Grouping patients according to the risk for and site of disease recurrence may be instrumental in the development of clinical trials that assess therapeutic approaches in appropriate subsets of patients.
前列腺癌的解剖范围长期以来一直发挥着提供预后信息的作用，以协助治疗决策、评估治疗结果、促进医学中心之间的信息交流以及推动癌症研究。然而，非解剖学因素也与该疾病的重要病理特征相关，并且可用于估计治疗结果。目前，从诊断性活检标本确定的肿瘤分级（如 Gleason 评分）和治疗前血清前列腺特异性抗原水平在临床实践中很容易获得。这些信息可与临床肿瘤分期一起用于构建预测模型。这些模型可为前列腺外肿瘤扩展、精囊侵犯或盆腔淋巴结受累的可能性提供可靠估计。考虑这些信息在放射治疗方式的选择以及外照射放疗治疗体积的定义中可能起着至关重要的作用。这些相同的因素也与疾病复发相关，并且可以以某种方式结合起来估计个体患者和同质患者群体中癌症控制的前景。根据疾病复发的风险和部位对患者进行分组可能有助于开展临床试验，以评估适合患者亚组的治疗方法。
