Translational Prostate Cancer Group, Department of Oncology, Hutchison/MRC research centre, University of Cambridge, Cambridge, UK.
BJU Int. 2012 Mar;109(5):648-58. doi: 10.1111/j.1464-410X.2011.10596.x. Epub 2011 Sep 27.
• The optimal management of high-risk localised prostate cancer is a major challenge for urologists and oncologists. It is clear that multimodal therapy including radical local treatment is needed in these men to achieve the best outcomes. • External beam radiotherapy (EBRT) is an essential component of therapy either as a primary or adjuvant treatment. However, the role of radical prostatectomy (RP) is more controversial. Both methods are currently valid therapy options. • There have been many individual studies of EBRT and RP in high-risk disease, but no good quality large prospective randomized trials. • In EBRT, combination with neoadjuvant plus long-term adjuvant androgen-deprivation therapy (ADT) has been conclusively shown to improve outcomes and is widely considered the standard of care. • However, the role of RP has achieved recent prominence with several important studies. Published data from prospective randomized trials in patients after RP have shown that in men with adverse pathological features at surgery, the addition of adjuvant RT improves biochemical-free and progression-free survival. • More recently, studies from large-volume centres comparing EBRT and RP have provided intriguing suggestions of better outcomes with RP as the primary treatment. • An important question therefore, is which of the two methods provides the best outcome in men with localised high-risk disease. Crucially, does the combination of RP and selective adjuvant EBRT provide clinically significant better outcomes compared with EBRT alone? • In this review we discuss the current evidence for the role of RP for high-risk localised prostate cancer and define the parameters and urgent need for a prospective trial to test the role of surgery for this group of patients.
• 高危局限性前列腺癌的最佳治疗方法是泌尿科医生和肿瘤学家面临的重大挑战。显然，这些患者需要包括根治性局部治疗在内的多模式治疗，才能获得最佳结果。• 外照射放疗（EBRT）是治疗的重要组成部分，无论是作为主要治疗还是辅助治疗。然而，根治性前列腺切除术（RP）的作用更具争议性。这两种方法目前都是有效的治疗选择。• 已经有许多关于高危疾病的 EBRT 和 RP 的单独研究，但没有高质量的大型前瞻性随机试验。• 在 EBRT 中，联合新辅助加长期辅助雄激素剥夺治疗（ADT）已被证实可改善结果，被广泛认为是标准治疗方法。• 然而，RP 的作用最近因几项重要研究而备受关注。发表的前瞻性随机临床试验数据显示，在手术时具有不利病理特征的患者中，辅助放疗的加入可改善生化无进展和无进展生存期。• 最近，来自大容量中心的研究比较了 EBRT 和 RP，为 RP 作为主要治疗提供了更好结果的有趣提示。• 因此，一个重要的问题是，对于局限性高危疾病患者，这两种方法中的哪一种提供最佳结果。至关重要的是，RP 联合选择性辅助 EBRT 是否与单独 EBRT 相比提供了具有临床意义的更好结果？• 在这篇综述中，我们讨论了 RP 在高危局限性前列腺癌中的作用的现有证据，并确定了参数和迫切需要进行前瞻性试验来检验手术在这组患者中的作用。
