Montie James E
Department of Urology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
J Urol. 2006 Dec;176(6 Pt 2):S27-9; discussion S25-6. doi: 10.1016/j.juro.2006.06.073.
This study provides a perspective on initial treatment in select patients with high risk, localized prostate cancer.
A select literature review was done with commentary on the philosophy of initial surgery followed by adjuvant or salvage therapies.
Early detection and associated stage migration identify a cadre of men with unfavorable but apparently localized prostate cancer who historically would not have been viewed as appropriate candidates for radical prostatectomy. Decreased morbidity from radical prostatectomy and data demonstrating improved outcomes in some patients treated with multimodal therapy protocols provide a rationale for including radical prostatectomy as part of an aggressive treatment plan to achieve optimal local elimination of cancer. Data suggest that radical prostatectomy and adjuvant or possibly even salvage radiation therapy may provide the best elimination of large local cancers. Whether such an approach provides results that are better than or even as good as those of the common standard of radiation therapy plus androgen deprivation therapy remains to be seen and, if so, at what cost to the patient in terms of adverse effects. However, it is likely that optimal elimination of local disease is needed to achieve the maximum benefit from adjuvant systemic endocrine, chemotherapy or targeted treatments. In other words optimal local therapy may be necessary but not sufficient.
Initial radical prostatectomy may have a role for treating high risk localized prostate cancer.
本研究为特定高危局限性前列腺癌患者的初始治疗提供一种观点。
进行了一项特定文献综述，并对初始手术联合辅助或挽救性治疗的理念进行了评论。
早期检测及相关的分期迁移确定了一批患有预后不良但明显为局限性前列腺癌的男性患者，从历史角度看，他们不会被视为根治性前列腺切除术的合适候选人。根治性前列腺切除术发病率的降低以及多模式治疗方案治疗的部分患者结局改善的数据，为将根治性前列腺切除术纳入积极治疗计划以实现癌症的最佳局部清除提供了理论依据。数据表明，根治性前列腺切除术联合辅助或甚至可能是挽救性放射治疗可能能最佳地清除较大的局部肿瘤。这种方法的结果是否优于放射治疗加雄激素剥夺治疗这一常用标准，甚至是否与之相当，仍有待观察，若如此，就不良反应而言患者要付出何种代价。然而，可能需要最佳地清除局部疾病才能从辅助性全身内分泌治疗、化疗或靶向治疗中获得最大益处。换句话说，最佳的局部治疗可能是必要的，但并非充分的。
初始根治性前列腺切除术可能在治疗高危局限性前列腺癌中发挥作用。
