Sia M, Rosewall T, Warde T P
Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ont. , Canada.
Front Radiat Ther Oncol. 2008;41:15-25. doi: 10.1159/000139874.
The proper management of prostate cancer is dependent on appropriate risk categorization, based on pretreatment prostate-specific antigen (PSA), clinical stage and Gleason score (GS). The use of radiotherapy in low-risk (T1-T2a, PSA < 10 ng/ml and GS <or= 6) and intermediate-risk (T1/T2, PSA < 20 ng/ml and GS <or= 7) disease is well established, with comparable results to surgery in the era of modern radiation therapy. However, cancer-related outcomes in some radiotherapy patients might still be improved with the use of adjuvant hormonal therapy. There is presently no clear evidence to support its use in low-risk patients and benefits in intermediate-risk patients need to be elucidated in the era of dose-escalated radiation therapy. Hypofractionated radiotherapy using biologically equivalent doses also has the potential to improve the therapeutic index, given the low alpha / beta ratio of prostate cancer, and to reduce overall treatment time, but the most advantageous regimen needs to be determined. In patients with high-risk disease (T3-T4, PSA > 20 ng/ml or GS >or=6 8), radiation with hormones has become the standard treatment. The issues that remain focus on determining the optimal duration of hormones, assessing the use of locoregional dose escalation and determining the possible benefit from adjuvant chemotherapy.
前列腺癌的合理管理取决于基于治疗前前列腺特异性抗原（PSA）、临床分期和 Gleason 评分（GS）进行的适当风险分类。在低风险（T1-T2a，PSA < 10 ng/ml 且 GS ≤ 6）和中风险（T1/T2，PSA < 20 ng/ml 且 GS ≤ 7）疾病中，放射治疗的应用已得到充分确立，在现代放射治疗时代，其结果与手术相当。然而，在一些接受放射治疗的患者中，使用辅助激素治疗可能仍会改善与癌症相关的结局。目前尚无明确证据支持在低风险患者中使用该治疗，在剂量递增放射治疗时代，中风险患者的获益情况有待阐明。鉴于前列腺癌的低 α/β 比值，使用生物等效剂量的大分割放射治疗也有可能提高治疗指数，并缩短总体治疗时间，但最有利的方案仍需确定。在高风险疾病（T3-T4，PSA > 20 ng/ml 或 GS ≥ 8）患者中，激素联合放射治疗已成为标准治疗方法。仍然存在的问题集中在确定激素的最佳使用时长、评估局部区域剂量递增的应用以及确定辅助化疗可能带来的益处。
