Van Poppel H
Department of Urology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven, Belgium.
Eur Urol. 2001;39 Suppl 1:10-4. doi: 10.1159/000052544.
Radical prostatectomy may lead to cure as long as the cancer is confined to the prostate and all malignant cells are removed. However, clinical staging is inaccurate and a significant proportion of cT1-T2 patients have positive margins which increases the likelihood of disease progression within 5 years of surgery. Neoadjuvant hormone therapy is one option being used to increase the likelihood of prostate cancer cure after radical prostatectomy. Randomized clinical trials using neoadjuvant hormone therapy and radical prostatectomy have been conducted mainly in patients with cT1 and cT2 prostate cancer. A decrease in the number of positive surgical margins was found in cT1 and cT2 prostate cancer patients receiving neoadjuvant hormone therapy, with a further decrease in those receiving treatment over longer periods. In cT3 prostate cancer patients equivocal results have been obtained and further research is needed. None of the studies reported so far were able to define the impact of neoadjuvant treatment on the surgical management of locally advanced prostate cancer. Additional studies are required to determine the optimal type and duration of hormone treatment. Furthermore, long-term follow-up is needed to evaluate whether neoadjuvant therapy will improve overall survival. In the meantime, patients must be informed of the advantages and disadvantages of treatment to allow them to make informed treatment decisions.
只要癌症局限于前列腺且所有恶性细胞均被切除，根治性前列腺切除术就可能实现治愈。然而，临床分期并不准确，相当一部分cT1-T2期患者存在手术切缘阳性的情况，这增加了术后5年内疾病进展的可能性。新辅助激素治疗是一种用于提高根治性前列腺切除术后前列腺癌治愈率的方法。使用新辅助激素治疗和根治性前列腺切除术的随机临床试验主要在cT1和cT2期前列腺癌患者中进行。在接受新辅助激素治疗的cT1和cT2期前列腺癌患者中，手术切缘阳性的数量有所减少，接受更长疗程治疗的患者减少得更多。对于cT3期前列腺癌患者，结果尚不明确，仍需进一步研究。目前报道的所有研究均未能明确新辅助治疗对局部晚期前列腺癌手术治疗的影响。需要更多研究来确定激素治疗的最佳类型和疗程。此外，需要长期随访以评估新辅助治疗是否能改善总生存期。与此同时，必须告知患者治疗的利弊，以便他们做出明智的治疗决策。
