Martiniclinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
Crit Rev Oncol Hematol. 2012 Dec;84 Suppl 1:e24-9. doi: 10.1016/j.critrevonc.2010.09.004. Epub 2011 May 25.
The optimal treatment for clinically localized prostate cancer is an ongoing subject of controversy. Treatment decisions must take tumour staging, risk assessment, life expectancy and consideration of the major side effects of multiple available treatment regimens into account. Despite technical advances reduced the side effects of radiation therapy, the majority of patients with newly diagnosed organ confined prostate cancer decide to undergo radical prostatectomy. Refinements of radical prostatectomy surgical techniques during the last decade are influenced by better understanding of the anatomy of the small pelvis and resulted in excellent functional and oncological outcomes. Additionally, the surgeons experience was identified as a key determinant for improved surgical outcomes. Recently, retrospective studies revealed that also patients with locally advanced disease benefit from radical prostatectomy. Advantages of radical prostatectomy include a precise pathological staging that assesses the need for additional therapies. Moreover, PSA can easily be used as an accurate surrogate marker during follow-up in such patients.
对于局限性前列腺癌的最佳治疗方法一直存在争议。治疗决策必须考虑肿瘤分期、风险评估、预期寿命以及多种可用治疗方案的主要副作用。尽管技术进步降低了放射治疗的副作用，但大多数新诊断为局限性前列腺癌的患者决定接受根治性前列腺切除术。过去十年中，根治性前列腺切除术手术技术的改进受到对小骨盆解剖结构更好理解的影响，并且取得了极佳的功能和肿瘤学结果。此外，外科医生的经验被认为是提高手术效果的关键决定因素。最近，回顾性研究表明，局部进展期疾病的患者也从根治性前列腺切除术获益。根治性前列腺切除术的优点包括精确的病理分期，可评估是否需要额外的治疗。此外，在这些患者的随访中，PSA 可以很容易地用作准确的替代标志物。
