Lineberger Comprehensive Cancer Center, UNC-Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599-7235, USA.
J Natl Compr Canc Netw. 2010 Feb;8(2):228-37. doi: 10.6004/jnccn.2010.0015.
Recent developments in the urologic oncology literature suggest that residual local disease--as opposed to the presence of occult metastases at surgery--may characterize a more substantial component of the natural history of the recurrence and progression of initially clinically localized prostate cancer than previously appreciated. These important studies have illuminated the extent to which postoperative radiotherapy (RT) may provide benefit to patients with adverse pathologic features (extraprostatic extension, seminal vesicle invasion, or positive surgical margins) or biochemical recurrence after radical prostatectomy. Nevertheless, the question of whether all patients with the aforementioned adverse features should undergo immediate adjuvant RT versus initial observation with more selective--but early--salvage RT in the event of biochemical failure remains the subject of heated controversy. This article reviews salient recent studies in this field to address important questions relevant to counseling patients on the use of postprostatectomy RT. Discussion points include data supporting benefit (efficacy), questions of generalizability of benefit (effectiveness) and risks, and important questions for further study.
泌尿科肿瘤学文献的最新进展表明，与手术时隐匿性转移的存在相反，残留的局部疾病可能是最初临床局限性前列腺癌复发和进展的自然史的一个更重要组成部分，这比以前认识到的更为明显。这些重要的研究阐明了术后放疗（RT）在多大程度上可以使具有不良病理特征（前列腺外延伸、精囊侵犯或手术切缘阳性）或根治性前列腺切除术后生化复发的患者受益。然而，对于上述具有不良特征的所有患者，是否都应立即接受辅助 RT，还是在生化失败时进行更具选择性但早期的挽救性 RT 观察，这仍然是激烈争议的问题。本文综述了该领域的最新重要研究，以解决与告知患者使用前列腺切除术后 RT 相关的重要问题。讨论要点包括支持获益（疗效）的数据、获益的普遍性（有效性）和风险问题，以及进一步研究的重要问题。
