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[德国泌尿外科医生和放射肿瘤学家若个人被诊断为局限性前列腺癌时的治疗选择]

[Therapy choices of German urologists and radio-oncologists if personally diagnosed with localized prostate cancer].

作者信息

Gillitzer R, Hampel C, Thomas C, Schmidt F, Melchior S W, Pahernik S, Schmidberger H, Thüroff J W

机构信息

Klinik und Poliklinik für Urologie, Johannes-Gutenberg-Universität, Langenbeckstrasse 1, 55131, Mainz, Deutschland.

出版信息

Urologe A. 2009 Apr;48(4):399-407. doi: 10.1007/s00120-008-1928-6.

Abstract

INTRODUCTION

We evaluated the currently preferred primary treatment options among German urologists and radio-oncologists if personally diagnosed with localized prostate cancer, taking into consideration the different prognostic risk groups.

MATERIALS AND METHODS

A questionnaire was mailed to 3,217 urologists and 598 radio-oncologists. They were asked to choose their preferred primary treatment option if they were personally diagnosed with prostate cancer, taking into consideration the different prognostic risk groups: low risk [Gleason score < or =6, prostate-specific antigen (PSA) < or =10 microg/l, T1c], intermediate risk (Gleason score 7, PSA 11-19 microg/l, T2), and high risk (Gleason score > or =8, PSA> or =20 microg/l, T3). Surgical options were further subdivided according to technique (retropubic, laparoscopic, perineal).

RESULTS

The questionnaire return rate was 49% for urologists and 41% for radio-oncologists. The mean age was 48 years (28-86) for urologists and 47 years (29-68) for radio-oncologists. Primary surgical treatment was selected by 62% of urologists for low-risk prostate cancer, 90% for intermediate-risk prostate cancer, and 77% for high-risk prostate cancer. Radiotherapy as a primary treatment option was elected by 71% of radio-oncologists for low-risk prostate cancer, 84% for intermediate-risk prostate cancer, and 89% for high-risk prostate cancer. Retropubic, laparoscopic, and perineal prostatectomy would be chosen by 61%, 28%, and 10% of urologists, respectively, for low-risk prostate cancer; by 70%, 24%, and 6%, respectively, for intermediate-risk prostate cancer, and by 80%, 15%, and 5%, respectively for high-risk prostate cancer.

CONCLUSION

Urologists prefer surgery and radio-oncologists radiotherapy for primary treatment of prostate cancer, irrespective of the prognostic risk group. Particularly for high-risk prostate cancer, the majority of radiooncologists would still choose radiotherapy as a primary treatment option. In the age of minimally invasive surgery, radical retropubic prostatectomy is still the preferred surgical treatment option among urologists for any prognostic risk group.

摘要

引言

我们评估了德国泌尿外科医生和放射肿瘤学家在个人被诊断为局限性前列腺癌时,目前倾向的主要治疗选择,并考虑了不同的预后风险组。

材料与方法

向3217名泌尿外科医生和598名放射肿瘤学家邮寄了一份问卷。要求他们在个人被诊断为前列腺癌时,考虑不同的预后风险组(低风险[Gleason评分≤6、前列腺特异性抗原(PSA)≤10μg/l、T1c]、中风险[Gleason评分7、PSA 11 - 19μg/l、T2]和高风险[Gleason评分≥8、PSA≥20μg/l、T3]),选择他们倾向的主要治疗选择。手术选项根据技术(耻骨后、腹腔镜、会阴)进一步细分。

结果

泌尿外科医生的问卷回复率为49%,放射肿瘤学家为41%。泌尿外科医生的平均年龄为48岁(28 - 86岁),放射肿瘤学家为得47岁(29 - 68岁)。62%的泌尿外科医生选择对低风险前列腺癌进行手术治疗,90%选择对中风险前列腺癌进行手术治疗,77%选择对高风险前列腺癌进行手术治疗。71%的放射肿瘤学家选择放疗作为低风险前列腺癌的主要治疗选择,84%选择对中风险前列腺癌进行放疗,89%选择对高风险前列腺癌进行放疗。对于低风险前列腺癌,分别有61%、28%和10%的泌尿外科医生会选择耻骨后前列腺切除术、腹腔镜前列腺切除术和会阴前列腺切除术;对于中风险前列腺癌,分别为70%、24%和6%;对于高风险前列腺癌,分别为80%、15%和5%。

结论

泌尿外科医生倾向于手术治疗,而放射肿瘤学家倾向于放疗作为前列腺癌的主要治疗方法,无论预后风险组如何。特别是对于高风险前列腺癌,大多数放射肿瘤学家仍会选择放疗作为主要治疗选择。在微创手术时代,耻骨后根治性前列腺切除术仍是泌尿外科医生对任何预后风险组首选的手术治疗方法。

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