Heidenreich Axel, Aus Gunna, Bolla Michel, Joniau Steven, Matveev Vsevolod B, Schmid Hans Peter, Zattoni Filliberto
Servicio de Urología, Hospital Universitario de Colonia, Colonia, Alemania.
Actas Urol Esp. 2009 Feb;33(2):113-26. doi: 10.1016/s0210-4806(09)74110-5.
OBJECTIVES: To present a summary of the 2007 version of the European Association of Urology (EAU) guidelines on prostate cancer (PCa). METHODS: A literature review of the new data emerging from 2004 to 2007 was performed by the working panel. The guidelines have been updated, and the level of evidence/grade of recommendation was added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. RESULTS: A full version is available at the EAU Office or at www.uroweb.org. Systemic prostate biopsy under ultrasound guidance is the preferred diagnostic method. Active treatment is mostly recommended for patients with localized disease and a long life expectancy, with radical prostatectomy being shown to be superior to watchful waiting in a prospective randomized trial. Nerve-sparing radical prostatectomy represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. Radiation therapy should be performed with at least 72 and 78 Gy in low-risk and intermediate- to high-risk PCa, respectively. Monotherapeutic androgen deprivation is the standard of care in metastatic PCa; intermittent androgen deprivation might be an alternative treatment option for selected patients. Follow-up is largely based on prostate-specific antigen and a disease-specific history with imaging only indicated when symptoms occur. Cytotoxic therapy with docetaxel has emerged as the reference treatment for metastatic hormone-refractory PCa. CONCLUSIONS: The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice.
目的:总结欧洲泌尿外科学会(EAU)2007年版前列腺癌(PCa)指南。 方法:工作小组对2004年至2007年出现的新数据进行了文献综述。指南已更新,并根据文献系统综述在文本中添加了证据水平/推荐等级,该综述包括在线数据库检索和文献综述。 结果:完整版本可在EAU办公室或www.uroweb.org获取。超声引导下的系统性前列腺活检是首选的诊断方法。对于局限性疾病且预期寿命较长的患者,大多推荐积极治疗,在前瞻性随机试验中,根治性前列腺切除术已被证明优于观察等待。保留神经的根治性前列腺切除术是器官局限性疾病的首选方法;新辅助雄激素剥夺治疗未显示出结局变量的改善。低危和中高危PCa的放射治疗分别应给予至少72 Gy和78 Gy。单一雄激素剥夺治疗是转移性PCa的标准治疗;间歇性雄激素剥夺可能是部分患者的替代治疗选择。随访主要基于前列腺特异性抗原和疾病特异性病史,仅在出现症状时才进行影像学检查。多西他赛细胞毒性治疗已成为转移性激素难治性PCa的参考治疗方法。 结论:PCa领域的知识正在迅速变化。这些EAU前列腺癌指南总结了最新发现并将其应用于临床实践。
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