Department of Surgery, Memorial Sloan-Kettering Cancer Center, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY 10065, USA.
Urol Oncol. 2010 Sep-Oct;28(5):557-67. doi: 10.1016/j.urolonc.2009.12.012.
To summarize the presentations and debate regarding the optimal treatment of localized high-risk prostate cancer as presented at the 2009 Spring Meeting of the Society of Urologic Oncology.
The debate was centered on presentations arguing for radical prostatectomy (RP) or radiotherapy as the optimal treatment for this condition. The meeting presentations are summarized by their respective presenters herein.
Dr. James Eastham presents the varied definitions for "high-risk" prostate cancer as strongly influencing which patients end up in this cohort. Based upon this, between 3% and 38% of patients with high-risk features could be defined as "high-risk". Despite that, these men do not have a uniformly poor prognosis after RP, and attention to surgical principles as outlined improve outcomes. Disease-specific survival at 12 years is excellent and up to one-half of these men may not need adjuvant or salvage therapies, depending on their specific disease characteristics. Adjuvant or salvage radiotherapies improve outcomes and are part of a sequential approach to treating these patients. Dr. Anthony Zietman presented radiotherapy as the gold-standard based upon large, randomized clinical trials of intermediate- and high-risk prostate cancer patients. Compared with androgen deprivation alone, the addition of radiotherapy provided a 12% cancer-specific survival advantage and 10% overall survival advantage. Dose escalation seems to confer further improvements in cancer control without significant escalation of toxicities, with more data forthcoming.
There are no randomized trials comparing RP to radiotherapy for any risk category. In high-risk prostate cancer patients, both approaches have potential benefits and cumulative toxicities that must be matched to disease characteristics and patient expectations in selecting a treatment course.
总结在 2009 年泌尿肿瘤外科学会春季会议上提出的关于局限性高危前列腺癌最佳治疗方法的演讲和辩论。
辩论集中在支持根治性前列腺切除术（RP）或放疗作为该疾病最佳治疗方法的演讲上。会议演讲由各自的演讲者在此总结。
James Eastham 博士介绍了“高危”前列腺癌的不同定义，这些定义强烈影响了哪些患者最终属于这一队列。基于此，有 3%至 38%的具有高危特征的患者可以被定义为“高危”。尽管如此，这些患者在 RP 后并非普遍预后不良，关注外科原则可改善结局。12 年疾病特异性生存率非常高，根据具体疾病特征，其中一半患者可能不需要辅助或挽救性治疗。辅助或挽救性放疗可改善结局，是治疗这些患者的序贯方法的一部分。Anthony Zietman 博士提出放疗是基于中高危前列腺癌患者的大型随机临床试验的金标准。与单独雄激素剥夺治疗相比，放疗的加入提供了 12%的癌症特异性生存优势和 10%的总生存优势。剂量递增似乎在不显著增加毒性的情况下进一步提高了癌症控制率，更多数据即将公布。
目前尚无比较 RP 与放疗用于任何风险类别的随机试验。在高危前列腺癌患者中，两种方法都有潜在的益处，累积毒性必须与疾病特征和患者对治疗方案的期望相匹配。
