Klein E A, Kupelian P A
Section of Urology Oncology, Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Curr Treat Options Oncol. 2000 Dec;1(5):433-45. doi: 10.1007/s11864-000-0071-4.
Much controversy still surrounds the diagnosis and treatment of localized prostate cancer. Urologists generally believe that early detection and aggressive surgical therapy saves lives despite the absence of confirmatory randomized trials. Furthermore, a recent survey of radiation oncologists and urologists revealed marked polarization toward their own specialties when asked how they would counsel patients on therapy for newly diagnosed localized disease. Some issues are not controversial, however. There is general agreement that pretreatment tumor characteristics, including serum prostate-specific antigen level at diagnosis, tumor grade, and clinical stage as judged by digital rectal examination, are important prognosticators for treatment outcomes independent of the type of treatment. Also, there is sufficient experience with standard therapies (radical prostatectomy and external beam radiotherapy) to counsel patients on the chance for cure and the expected incidence of acute and chronic toxicities. A comparative evaluation of various therapies for prostate cancer should include consideration of cancer control, acute toxicity, treatment-related quality of life issues, salvage of treatment failures, and cost. Within this context, we believe that newly diagnosed patients should be counseled on all available treatment options before embarking on a course of therapy.
局限性前列腺癌的诊断和治疗仍然存在诸多争议。尽管缺乏确凿的随机试验，但泌尿科医生普遍认为早期检测和积极的手术治疗能挽救生命。此外，最近对放射肿瘤学家和泌尿科医生的一项调查显示，当被问及如何就新诊断的局限性疾病的治疗向患者提供建议时，他们对各自专业表现出明显的两极分化。然而，有些问题并无争议。人们普遍认为，治疗前的肿瘤特征，包括诊断时的血清前列腺特异性抗原水平、肿瘤分级以及通过直肠指检判断的临床分期，是独立于治疗类型的治疗结果的重要预后指标。此外，对于标准疗法（根治性前列腺切除术和外照射放疗）已有足够的经验，可为患者提供治愈机会以及急性和慢性毒性预期发生率的咨询。对前列腺癌各种疗法的比较评估应包括对癌症控制、急性毒性、与治疗相关的生活质量问题、治疗失败后的挽救措施以及成本的考量。在此背景下，我们认为新诊断的患者在开始治疗过程之前应被告知所有可用的治疗选择。
