Joniau Steven, Van Poppel Hein
Department of Urology, University Hospital Leuven, Leuven, Belgium.
BJU Int. 2008 Mar;101 Suppl 2:5-10. doi: 10.1111/j.1464-410X.2007.07488.x.
Prostate cancer encompasses a biological continuum from a slow-growing indolent tumour to a highly aggressive and potentially fatal form. A major challenge faced daily by physicians is to identify men with localized prostate cancer who are at high risk of dying from the disease, in order to maximize disease control and survival, without overtreating men who are likely to die from comorbidities. Treatment selection in patients with localized prostate cancer should be guided not only by patient-related factors (e.g. age and comorbidities), but also by cancer-related parameters (clinical stage, biopsy grade and preoperative prostate-specific antigen [PSA]) that enable patients to be classified as low, intermediate, or high risk for unfavourable outcomes. Surgery alone will only cure a fraction of high-risk patients. Instead these patients typically need a pro-active multimodal approach comprising a combination of surgery, radiotherapy and/or hormonal deprivation. The place of chemotherapy in the adjuvant or neoadjuvant setting in this patient group needs to be evaluated in clinical trials.
前列腺癌涵盖了一个生物学连续体，从生长缓慢的惰性肿瘤到极具侵袭性且可能致命的形式。医生每天面临的一项重大挑战是，识别出患有局限性前列腺癌且有高疾病死亡风险的男性，以便在不过度治疗可能死于合并症的男性的情况下，最大限度地控制疾病并提高生存率。局限性前列腺癌患者的治疗选择不仅应依据患者相关因素（如年龄和合并症），还应依据癌症相关参数（临床分期、活检分级和术前前列腺特异性抗原[PSA]），这些参数能将患者分类为低、中、高不良结局风险。仅手术只能治愈一部分高危患者。相反，这些患者通常需要一种积极的多模式方法，包括手术、放疗和/或激素剥夺的联合应用。该患者群体辅助或新辅助化疗的地位需要在临床试验中进行评估。
