Kibel A S, Nelson J B
Department of Surgery, Division of Urology, Washington University School of Medicine, St Louis, MO 63110, USA.
Prostate Cancer Prostatic Dis. 2007;10(2):119-26. doi: 10.1038/sj.pcan.4500947. Epub 2007 Feb 20.
The management of high-risk prostate cancer following radical prostatectomy remains a treatment dilemma. Multimodality approaches incorporating surgery, radiation therapy and systemic agents offer the hope of improved cure rates; however, most randomized studies to date are either immature or negative. The systemic treatment options best studied is androgen deprivation, which has been shown to demonstrate a survival advantage in patients with lymph node-positive disease. Systemic chemotherapy has demonstrated a modest survival advantage in androgen-independent disease. Current studies are exploring its role in the adjuvant and neo-adjuvant setting. Lastly, recent randomized trials have demonstrated a biochemical advantage to adjuvant radiation therapy, but it remains to be seen if this will translate to an improvement is survival end points or if salvage radiation therapy would be just as effective. In this update article, we review the use of external beam radiation therapy and systemic agents in combination with surgery for high-risk prostate cancer patients.
根治性前列腺切除术后高危前列腺癌的管理仍然是一个治疗难题。包含手术、放射治疗和全身治疗药物的多模式方法带来了提高治愈率的希望；然而，迄今为止大多数随机研究要么不成熟，要么得出阴性结果。研究最多的全身治疗选择是雄激素剥夺，已证明其在淋巴结阳性疾病患者中具有生存优势。全身化疗在雄激素非依赖性疾病中显示出适度的生存优势。目前的研究正在探索其在辅助和新辅助治疗中的作用。最后，最近的随机试验已证明辅助放射治疗具有生化优势，但这是否会转化为生存终点的改善，或者挽救性放射治疗是否同样有效，仍有待观察。在这篇更新文章中，我们回顾了外照射放疗和全身治疗药物联合手术在高危前列腺癌患者中的应用。
