Jani Ashesh B
Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
Drugs Aging. 2006;23(2):119-29. doi: 10.2165/00002512-200623020-00003.
Locally advanced prostate cancer represents a subpopulation of prostate cancer diagnosed in patients who are either untouched by screening efforts or whose disease has an unusually rapidly progressive natural history. The diagnostic work-up for the locally advanced patient is distinct from that of early stage disease in several respects in that it is related principally to ruling out metastases. The typical metastatic work-up consists of a serum alkaline phosphatase, bone scan, CT of the abdomen/pelvis, and chest x-ray. Once metastatic disease has been ruled out, individual components of the management of locally advanced prostate cancer patients may include surgery (palliative or curative), external beam radiation therapy (with photons or particles) or brachytherapy (with low-dose rate/permanent or high-dose rate/temporary radiation sources), and hormone therapy. Unlike in early stage disease, observation/watchful waiting is typically not a treatment option in locally advanced prostate cancer. Of the curative local control modalities, the one most commonly used, and the one which has emerged as the clinical standard, is photon external beam radiotherapy (EBRT). Numerous randomised studies have shown that androgen ablation has an established role in conjunction with radiotherapy for locally advanced disease--the current standard of care is thus photon EBRT plus neoadjuvant and adjuvant androgen ablation. Long-term androgen ablation appears to be better than short-term ablation, even when hormone complications are considered. EBRT is typically delivered to the prostate, seminal vesicles and pelvic lymph nodes, although in some circumstances local fields to the prostate and seminal vesicles may be adequate. New treatment planning and delivery techniques, such as intensity-modulated radiotherapy and organ motion tracking, are being developed to reduce the morbidity of radiotherapy while permitting a higher delivered dose. Further work is necessary to determine the precise sequencing and duration of hormone therapy in conjunction with radiotherapy and the optimum radiotherapy treatment volume. Additional work is also needed to determine the precise groups benefiting from other local control modalities such as surgery and brachytherapy. Finally, novel investigational strategies such as chemotherapy and gene therapy are being applied in an attempt to improve outcomes of locally advanced prostate cancer patients.
局部晚期前列腺癌是前列腺癌患者中的一个亚群，这些患者要么未接受筛查，要么其疾病具有异常快速进展的自然病程。局部晚期患者的诊断检查在几个方面与早期疾病不同，主要在于其主要与排除转移有关。典型的转移检查包括血清碱性磷酸酶、骨扫描、腹部/盆腔CT和胸部X光检查。一旦排除转移疾病，局部晚期前列腺癌患者管理的各个组成部分可能包括手术（姑息性或根治性）、外照射放疗（使用光子或粒子）或近距离放疗（使用低剂量率/永久性或高剂量率/临时性放射源）以及激素治疗。与早期疾病不同，观察/密切观察等待通常不是局部晚期前列腺癌的治疗选择。在根治性局部控制方式中，最常用且已成为临床标准的是光子外照射放疗（EBRT）。大量随机研究表明，雄激素剥夺在局部晚期疾病的放疗联合治疗中具有既定作用——因此目前的护理标准是光子EBRT加新辅助和辅助雄激素剥夺。即使考虑到激素并发症，长期雄激素剥夺似乎也优于短期剥夺。EBRT通常照射前列腺、精囊和盆腔淋巴结，尽管在某些情况下，仅照射前列腺和精囊的局部野可能就足够了。正在开发新的治疗计划和实施技术，如调强放疗和器官运动跟踪，以降低放疗的发病率，同时允许给予更高的剂量。需要进一步开展工作，以确定激素治疗与放疗联合使用的精确顺序和持续时间以及最佳放疗治疗体积。还需要开展额外工作，以确定从手术和近距离放疗等其他局部控制方式中获益的确切人群。最后，正在应用化疗和基因治疗等新型研究策略，试图改善局部晚期前列腺癌患者的治疗效果。
