Sylvester J, Grimm P, Blasco J, Meier R, Spiegel J, Heaney C, Cavanagh W
Seattle Prostate Institute, Seattle, Washington 98104, USA.
Urology. 2001 Aug;58(2 Suppl 1):65-70. doi: 10.1016/s0090-4295(01)01244-4.
To identify therapeutic patterns for putative prostate cancer treatment failures and the role played by androgen ablation therapy in these patients, a questionnaire study was undertaken with urologists and radiation oncologists who had attended a brachytherapy forum at the Seattle Prostate Institute (SPI). Hypothetical questions were asked about recommendations the physicians would give to a patient demonstrating biochemical or local failure after external-beam radiation therapy. Most of the physicians queried were in private practice; 53% were radiation oncologists and 47% were urologists. The respondents' recommendations for a hypothetical patient, who was 45 to 65 years of age, with a biopsy-proven local recurrence was treatment with androgen ablation (35% of respondents), radical prostatectomy (25%), interstitial brachytherapy (20%), and observation (19%). In the 65- to 75-year-old patient with a local recurrence, the respondents recommended observation (43%), androgen ablation (35%), interstitial brachytherapy (17%), and radical prostatectomy (4%). In patients receiving androgen ablation for a biochemical failure alone, there was no consensus on whether to use luteinizing hormone-releasing hormone agonist alone, total androgen ablation, orchiectomy, or intermittent androgen ablation. Criteria that prompted physicians to initiate androgen ablation were based on the rate of prostate-specific antigen (PSA) increase (67%), an absolute PSA number (24%), or clinical failure (9%). In the younger patient with a local recurrence, local intervention with radical prostatectomy or interstitial brachytherapy was recommended most often, followed by androgen ablation, then by observation. In the older patient, observation was recommended most often, followed closely by androgen ablation. Overall, there was a lack of consensus on how to deliver androgen ablation. However, there was remarkable agreement between urologists and radiation oncologists on virtually all issues queried.
为了确定假定的前列腺癌治疗失败的治疗模式以及雄激素剥夺疗法在这些患者中所起的作用，我们对参加西雅图前列腺研究所（SPI）近距离放射治疗论坛的泌尿科医生和放射肿瘤学家进行了一项问卷调查研究。我们提出了一些假设性问题，询问医生对于在外照射放疗后出现生化或局部失败的患者会给出何种建议。大多数接受询问的医生是私人执业医生；其中53%是放射肿瘤学家，47%是泌尿科医生。对于一名年龄在45至65岁、经活检证实为局部复发的假设患者，受访者的建议是进行雄激素剥夺治疗（35%的受访者）、根治性前列腺切除术（25%）、间质近距离放射治疗（20%）以及观察等待（19%）。对于一名年龄在65至75岁、出现局部复发的患者，受访者建议观察等待（43%）、雄激素剥夺治疗（35%）、间质近距离放射治疗（17%）以及根治性前列腺切除术（4%）。对于仅因生化失败而接受雄激素剥夺治疗的患者，在是否单独使用促黄体生成素释放激素激动剂、完全雄激素剥夺、睾丸切除术或间歇性雄激素剥夺方面没有达成共识。促使医生开始进行雄激素剥夺治疗的标准基于前列腺特异性抗原（PSA）升高的速率（67%）、PSA的绝对值（24%）或临床失败（9%）。对于较年轻的局部复发患者，最常建议的是采用根治性前列腺切除术或间质近距离放射治疗进行局部干预，其次是雄激素剥夺治疗，然后是观察等待。对于年龄较大的患者，最常建议的是观察等待，其次是雄激素剥夺治疗。总体而言，在如何进行雄激素剥夺治疗方面缺乏共识。然而，在几乎所有被询问的问题上，泌尿科医生和放射肿瘤学家之间都达成了显著的一致。
