Stratton Kelly L, Chang Sam S
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
BJU Int. 2009 Aug;104(4):449-54. doi: 10.1111/j.1464-410X.2009.08741.x.
Among the heterogeneous population of patients with prostate cancer, a high-risk group with locally advanced prostate cancer (LAPC) present a diagnostic and therapeutic dilemma. Although the incidence of LAPC has decreased with screening since the introduction of prostate-specific antigen (PSA) testing, significantly many patients are still diagnosed with LAPC. These patients are by definition at higher risk of metastatic disease and worse outcomes. The role of radical prostatectomy (RP) in this population has been debated, as the combination of radiotherapy and hormonal therapy is becoming used more frequently for LAPC. Unfortunately, the clinical staging and evaluation of LAPC is a challenge that results in possibly understaging or overstaging these patients. This further complicates therapeutic decision-making, and as a result no established standard treatment has been proposed. Like other patients with prostate cancer, individualized therapeutic choices are essential and depend on a multitude of factors. Herein we examine the role of RP for managing LAPC and attempt to emphasize how the risk of distant disease and difficulty with clinical staging might favour incorporating a surgical approach as part of the therapy for patients with LAPC.
在前列腺癌患者的异质性群体中，局部晚期前列腺癌（LAPC）的高危组面临着诊断和治疗难题。自引入前列腺特异性抗原（PSA）检测以来，尽管LAPC的发病率随筛查有所下降，但仍有相当多患者被诊断为LAPC。根据定义，这些患者发生转移性疾病的风险更高，预后更差。根治性前列腺切除术（RP）在该群体中的作用一直存在争议，因为放疗和激素治疗联合应用于LAPC越来越频繁。不幸的是，LAPC的临床分期和评估是一项挑战，可能导致这些患者分期不足或过度分期。这进一步使治疗决策复杂化，因此尚未提出既定的标准治疗方案。与其他前列腺癌患者一样，个体化治疗选择至关重要，且取决于多种因素。在此，我们探讨RP在LAPC治疗中的作用，并试图强调远处疾病风险和临床分期困难如何可能有利于将手术方法纳入LAPC患者的治疗方案。
