Middleton R G, Larsen R H
Department of Surgery, University of Utah Center for the Health Sciences, Salt Lake City.
Urol Clin North Am. 1990 Nov;17(4):779-85.
There are several areas of concern in dealing with clinical stage B disease. First, understaging is common. Second, recognition of extension into the seminal vesicles is important. Third, the patient's predicted life expectancy must be taken into account. Moreover, even clinically localized prostate cancer may have metastasized, and the need for surgical staging by lymph node dissection has been a significant factor in the authors' preference for radical retropubic rather than radical perineal prostatectomy. Neither of the two serum markers in clinical use is an absolute predictor of stage. Analysis of tumor ploidy may prove useful, and transrectal ultrasound warrants further study. In the elderly patient, the urologist certainly may elect to monitor the tumor without definitely deciding on operative versus conservative treatment.
在处理临床B期疾病时存在几个需要关注的方面。首先，分期不足很常见。其次，识别肿瘤是否侵犯精囊很重要。第三，必须考虑患者的预期寿命。此外，即使是临床局限性前列腺癌也可能已经发生转移，而通过淋巴结清扫进行手术分期的必要性一直是作者倾向于选择耻骨后根治性前列腺切除术而非经会阴根治性前列腺切除术的一个重要因素。目前临床使用的两种血清标志物都不是分期的绝对预测指标。肿瘤倍体分析可能有用，经直肠超声值得进一步研究。对于老年患者，泌尿外科医生当然可以选择监测肿瘤，而不确定选择手术治疗还是保守治疗。
