Eggener Scott E, Coleman Jonathan A
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA.
ScientificWorldJournal. 2008 Oct 3;8:963-73. doi: 10.1100/tsw.2008.127.
Epidemiologic and pathologic features of prostate cancer have given rise to an interest in focal treatment for carefully selected patients. Prostate cancer remains highly prevalent, particularly in the United States and Europe. As screening programs have become more aggressive and widespread, a substantial proportion of men diagnosed with localized prostate cancer have disease characteristics associated with a low risk of progression. Treatments such as radical prostatectomy and radiation therapy can lead to durable recurrence-free survival in most patients but carry variable risks of bowel, urinary, and sexual side effects. Few men and few urologists are comfortable leaving a potentially curable prostate cancer untreated. Focal therapy offers an attractive alternative to the patient faced with a choice between aggressive local intervention (radiation or surgery) and watchful waiting. Contemporary diagnostic biopsy strategies and imaging tools and the development of predictive statistical models (nomograms) have led to improvements in tumor characterization and risk-stratification, making focal therapy a viable treatment option for specific men. This article reviews the rationale and indications for focal therapy and highlights vascular-targeted photodynamic therapy (PDT) as one of many promising focal therapy techniques.
前列腺癌的流行病学和病理特征引发了人们对为精心挑选的患者进行局部治疗的兴趣。前列腺癌仍然非常普遍，尤其是在美国和欧洲。随着筛查计划变得更加积极和广泛，相当一部分被诊断为局限性前列腺癌的男性具有与低进展风险相关的疾病特征。根治性前列腺切除术和放射治疗等治疗方法可以使大多数患者实现持久的无复发生存，但会带来不同程度的肠道、泌尿和性功能方面的副作用风险。很少有男性和泌尿外科医生愿意对潜在可治愈的前列腺癌不进行治疗。对于面临积极局部干预（放疗或手术）和密切观察等待之间选择的患者，局部治疗提供了一个有吸引力的替代方案。当代诊断性活检策略和成像工具以及预测性统计模型（列线图）的发展，已使肿瘤特征描述和风险分层得到改善，使局部治疗成为特定男性可行的治疗选择。本文回顾了局部治疗的基本原理和适应症，并重点介绍了血管靶向光动力疗法（PDT），它是众多有前景的局部治疗技术之一。
