Xylinas E, Misraï V, Comperat E, Renard-Penna R, Vaessen C, Bitker M-O, Chartier-Kastler E, Richard F, Cussenot O, Rouprêt M
Services d'urologie, hôpital de la Pitié-Salpêtrière, hôpital Tenon, Assistance publique-Hôpitaux de Paris, groupe hospitalo-universitaire Est, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, boulevard de l'Hôpital, Paris, France.
Prog Urol. 2009 May;19(5):285-90. doi: 10.1016/j.purol.2009.01.008. Epub 2009 Mar 9.
According to current literature, the gold standard treatment for T3 prostate cancer is the combination of radiotherapy and extended hormonotherapy. Clinical staging based on digital rectal examination seems useless nowadays, since 20% of T3 prostate cancer is overevaluated during physical examination. Prostatic MRI is extensively needed to evaluate extraprostatic extension during preoperative work-up. EAU guidelines recommend radical prostatecomy only in selected patients: less than or equal to cT3a, PSA less than 20 ng/ml and biopsy Gleason score less than or equal to 8. Carcinologic control obtained after radical prostatectomy is variable from one series to another, with biochemical free survival rate at 5, 10 and 15 years that range from 45 to 62%, 43 to 51%, and 38 to 49%. Specific survival rates at 5, 10 and 15 years are, respectively, of 84 to 98%, 85 to 91% and 76 to 84%. Surgical margins rate differ from 22 up to 61% corresponding to several operative techniques and surgeon's own experience. Regarding urinary continence, functional outcomes are in line with those of prostatectomy for localized prostate cancer. Considering erectile dysfunction, rates are linked with the type of surgery, which can be extensive or not. There is no impact on overall or specific survival of neoadjuvant treatments. One current question remains the efficacy of early adjuvant treatment after prostatectomy, especially adjuvant irradiation. Radical prostatectomy can be considered in selected cases as a viable alternative first-line treatment option. However, patients have to be warned that they may undergo complementary treatments during the postoperative course of the disease.
根据当前文献，T3期前列腺癌的金标准治疗方法是放疗与延长激素治疗相结合。如今，基于直肠指检的临床分期似乎已无用处，因为20%的T3期前列腺癌在体格检查时被过度评估。在术前检查中，广泛需要前列腺MRI来评估前列腺外侵犯情况。欧洲泌尿外科学会（EAU）指南仅推荐在特定患者中进行根治性前列腺切除术：cT3a期及以下、前列腺特异性抗原（PSA）低于20 ng/ml且活检Gleason评分小于或等于8分。根治性前列腺切除术后获得的肿瘤学控制在不同系列中有所不同，5年、10年和15年的无生化复发生存率分别为45%至62%、43%至51%和38%至49%。5年、10年和15年的特异性生存率分别为84%至98%、85%至91%和76%至84%。手术切缘率因手术技术和外科医生自身经验不同而在22%至61%之间。关于尿失禁，功能结局与局限性前列腺癌前列腺切除术的结局一致。考虑到勃起功能障碍，发生率与手术类型有关，手术类型可能广泛或不广泛。新辅助治疗对总生存或特异性生存没有影响。当前一个问题仍然是前列腺切除术后早期辅助治疗的疗效，尤其是辅助放疗。在某些特定情况下，根治性前列腺切除术可被视为一种可行的一线替代治疗选择。然而，必须警告患者，在疾病的术后过程中他们可能需要接受辅助治疗。
