Department of Urology of GHU EST (Pitié), Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI Paris, France.
BJU Int. 2010 Dec;106(11):1596-600. doi: 10.1111/j.1464-410X.2010.09630.x. Epub 2010 Sep 14.
According to the literature, the current preferred treatment for T3 prostate cancer is a combination of radiotherapy and extended hormone therapy. The preoperative staging based on digital rectal examination results alone now appears obsolete from the investigated series, in which 20% of T3 prostate cancer is over-staged during physical examination. Prostatic magnetic resonance imaging is becoming increasingly necessary to evaluate extraprostatic extension during the preoperative evaluation. European Association of Urology guidelines recommend the use of radical prostatectomy only in selected patients with cT3a who have a PSA <20 ng/mL and a biopsy Gleason score ≤8. The cancer control obtained after the implementation of radical prostatectomy is variable from one series to another, with PSA-free survival rates at 5, 10 and 15 years ranging from 45 to 62%, 43 to 51% and 15 to 49%, respectively. The specific survival rates at 5, 10 and 15 years are between 84 and 98%, 84 and 91% and 76 and 84%, respectively. The surgical margins rate varies from 22% to 61% depending on the specific operative technique used and the surgeon's own experience level. Regarding urinary continence, functional outcomes are in line with those of prostatectomy for localized prostate cancer. Upon consideration of erectile dysfunction, the rates are linked with the type of surgery performed, which can at times be fairly extensive. There is no impact on the overall or specific survival rate of neoadjuvant treatments. One of the problems currently depends on the efficacy of early adjuvant treatment after prostatectomy, especially regarding the use of adjuvant external beam radiotherapy. Radical prostatectomy can be considered in selected cases as a viable alternative to the first-line treatment option. However, patients must be counselled that they may undergo complementary treatments during the postoperative course of the disease.
根据文献，目前 T3 前列腺癌的首选治疗方法是放疗联合延长激素治疗。从我们的研究系列来看，仅基于直肠指检结果的术前分期现在似乎已经过时，因为在体格检查中，20%的 T3 前列腺癌存在过度分期。在术前评估中，前列腺磁共振成像对于评估前列腺外延伸变得越来越必要。欧洲泌尿外科协会指南建议仅在少数 PSA<20ng/mL 和活检 Gleason 评分≤8 的 cT3a 患者中选择使用根治性前列腺切除术。根治性前列腺切除术后的癌症控制效果因系列而异，PSA 无复发生存率在 5、10 和 15 年时分别为 45%至 62%、43%至 51%和 15%至 49%。特定的 5、10 和 15 年生存率分别为 84%至 98%、84%至 91%和 76%至 84%。手术切缘率因具体手术技术和外科医生自身经验水平的不同而有所不同，从 22%到 61%不等。关于尿控，功能结果与局限性前列腺癌前列腺切除术的结果一致。考虑到勃起功能障碍，这些比率与所进行的手术类型有关，有时手术类型相当广泛。新辅助治疗对总生存率或特定生存率没有影响。目前的一个问题取决于前列腺切除术后早期辅助治疗的疗效，尤其是辅助外照射放疗的应用。在某些情况下，可以将根治性前列腺切除术作为一线治疗方案的可行替代方案。但是，患者必须被告知，他们可能在疾病的术后过程中需要接受补充治疗。
