Bittner Nathan, Merrick Gregory S, Wallner Kent E, Butler Wayne M
Department of Radiation Oncology University of Washington Seattle, Washington, USA.
Oncology (Williston Park). 2008 Aug;22(9):995-1004; discussion 1006, 1011-7.
High-risk prostate cancer represents a therapeutic challenge for both the urologist and radiation oncologist. Biochemical outcomes with radical prostatectomy and external-beam radiation therapy are poor in this subset of patients. These unfavorable results have led some to believe that high-risk prostate cancer is not curable with conventional treatment approaches, which has been an impetus for many of the current trials using neoadjuvant chemotherapy and prostatectomy. With the established efficacy of interstitial brachytherapy, these efforts are likely excessive. Most modern trials indicate excellent biochemical control rates among high-risk patients treated with an aggressive locoregional approach that includes brachytherapy. A thoughtful review of the literature would suggest that interstitial brachytherapy offers a therapeutic advantage over other local treatment modalities and should be considered standard treatment for aggressive organ-confined prostate cancer.
高危前列腺癌对泌尿外科医生和放射肿瘤学家来说都是一项治疗挑战。在这类患者中，根治性前列腺切除术和外照射放疗的生化结果较差。这些不理想的结果导致一些人认为，传统治疗方法无法治愈高危前列腺癌，这推动了目前许多使用新辅助化疗和前列腺切除术的试验。鉴于间质近距离放射治疗已证实的疗效，这些努力可能是过度的。大多数现代试验表明，采用包括近距离放射治疗在内的积极局部区域治疗方法治疗的高危患者，生化控制率极佳。对文献进行深入回顾会发现，间质近距离放射治疗比其他局部治疗方式具有治疗优势，应被视为侵袭性器官局限性前列腺癌的标准治疗方法。
