Wirth Manfred P, Hakenberg Oliver W, Froehner Michael
Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden , Germany.
Front Radiat Ther Oncol. 2008;41:39-48. doi: 10.1159/000139877.
Several randomized trials have demonstrated that adjuvant medical or surgical castration may improve overall survival in patients with locally advanced prostate cancer undergoing external beam radiotherapy. After radical prostatectomy, patients with positive lymph nodes seem to benefit from adjuvant hormonal treatment rather than from treatment at the time of clinical progression in terms of overall survival. In patients with locally advanced, lymph node-negative prostate cancer, adjuvant hormonal treatment after radical prostatectomy has been demonstrated to delay progression without impact on survival. The Bicalutamide Early Prostate Cancer Program, the largest ongoing prostate cancer trial in the world, investigates the effect of early treatment with 150 mg bicalutamide compared with placebo as monotherapy or adjuvant treatment after radical prostatectomy or external beam radiotherapy. It demonstrated that early treatment with bicalutamide may delay objective progression of prostate cancer irrespective of primary treatment. Considering overall survival, however, there was an advantage only in the setting of external beam radiotherapy for locally advanced prostate cancer. In patients with localized disease who initially underwent watchful waiting, there was a trend to decreased survival in the arm immediately treated with bicalutamide. Altogether, there is no indication for treatment with bicalutamide in patients with localized disease.
多项随机试验表明，辅助性药物去势或手术去势可提高接受外照射放疗的局部晚期前列腺癌患者的总生存率。根治性前列腺切除术后，淋巴结阳性的患者在总生存率方面似乎从辅助性激素治疗中获益，而非临床进展时的治疗。在局部晚期、淋巴结阴性的前列腺癌患者中，根治性前列腺切除术后辅助性激素治疗已被证明可延缓疾病进展，但对生存率无影响。比卡鲁胺早期前列腺癌项目是世界上正在进行的最大规模前列腺癌试验，该项目研究了与安慰剂相比，150毫克比卡鲁胺早期治疗作为单一疗法或根治性前列腺切除术后或外照射放疗后的辅助治疗的效果。结果表明，无论初始治疗如何，比卡鲁胺早期治疗均可延缓前列腺癌的客观进展。然而，考虑到总生存率，仅在局部晚期前列腺癌的外照射放疗情况下比卡鲁胺治疗具有优势。在最初接受观察等待的局限性疾病患者中，立即接受比卡鲁胺治疗的组有生存率降低的趋势。总体而言，对于局限性疾病患者，没有使用比卡鲁胺治疗的指征。
