Prostate Cancer Center of Seattle, WA, USA.
BJU Int. 2012 Feb;109 Suppl 1:22-9. doi: 10.1111/j.1464-410X.2011.10827.x.
What's known on the subject? and What does the study add? Very few comparative studies to date evaluate the results of treatment options for prostate cancer using the most sensitive measurement tools. PSA has been identified as the most sensitive tool for measuring treatment effectiveness. To date, comprehensive unbiased reviews of all the current literature are limited for prostate cancer. This is the first large scale comprehensive review of the literature comparing risk stratified patients by treatment option and with long-term follow-up. The results of the studies are weighted, respecting the impact of larger studies on overall results. The study identified a lack of uniformity in reporting results amongst institutions and centres. A large number of studies have been conducted on the primary therapy of prostate cancer but very few randomized controlled trials have been conducted. The comparison of outcomes from individual studies involving surgery (radical prostatectomy or robotic radical prostatectomy), external beam radiation (EBRT) (conformal, intensity modulated radiotherapy, protons), brachytherapy, cryotherapy or high intensity focused ultrasound remains problematic due to the non-uniformity of reporting results and the use of varied disease outcome endpoints. Technical advances in these treatments have also made long-term comparisons difficult. The Prostate Cancer Results Study Group was formed to evaluate the comparative effectiveness of prostate cancer treatments. This international group conducted a comprehensive literature review to identify all studies involving treatment of localized prostate cancer published during 2000-2010. Over 18,000 papers were identified and a further selection was made based on the following key criteria: minimum/median follow-up of 5 years; stratification into low-, intermediate- and high-risk groups; clinical and pathological staging; accepted standard definitions for prostate-specific antigen failure; minimum patient number of 100 in each risk group (50 for high-risk group). A statistical analysis (standard deviational ellipse) of the study outcomes suggested that, in terms of biochemical-free progression, brachytherapy provides superior outcome in patients with low-risk disease. For intermediate-risk disease, the combination of EBRT and brachytherapy appears equivalent to brachytherapy alone. For high-risk patients, combination therapies involving EBRT and brachytherapy plus or minus androgen deprivation therapy appear superior to more localized treatments such as seed implant alone, surgery alone or EBRT. It is anticipated that the study will assist physicians and patients in selecting treatment for men with newly diagnosed prostate cancer.
关于这个主题已经知道了什么？本研究增加了什么新内容？迄今为止，很少有比较研究使用最敏感的测量工具来评估前列腺癌治疗方案的结果。PSA 已被确定为测量治疗效果最敏感的工具。迄今为止，对于前列腺癌，全面、公正的综合文献综述是有限的。这是第一次对所有当前文献进行大规模的综合审查，比较了按治疗选择和长期随访分层的风险患者。研究结果经过加权处理，尊重较大研究对总体结果的影响。研究发现，各机构和中心在报告结果方面缺乏一致性。已经进行了大量关于前列腺癌主要治疗的研究，但很少有随机对照试验。由于报告结果的非一致性以及使用不同的疾病结果终点，手术（根治性前列腺切除术或机器人根治性前列腺切除术）、外束放射治疗（EBRT）（适形、调强放疗、质子）、近距离放射治疗、冷冻治疗或高强度聚焦超声的个别研究结果比较仍然存在问题。这些治疗方法的技术进步也使得长期比较变得困难。前列腺癌结果研究组成立的目的是评估前列腺癌治疗方法的比较效果。该国际小组进行了全面的文献综述，以确定在 2000-2010 年期间发表的所有涉及局部前列腺癌治疗的研究。确定了超过 18000 篇论文，并根据以下关键标准进一步进行了选择：最低/中位数随访 5 年；分层为低、中、高风险组；临床和病理分期；接受前列腺特异性抗原失败的标准定义；每个风险组至少有 100 名患者（高危组为 50 名）。研究结果的统计分析（标准偏差椭圆）表明，在生化无进展方面，近距离放射治疗为低危疾病患者提供了更好的结果。对于中危疾病，EBRT 和近距离放射治疗联合治疗与单独近距离放射治疗效果相当。对于高危患者，EBRT 和近距离放射治疗联合加或不加雄激素剥夺治疗的联合治疗似乎优于更局部的治疗方法，如单独种子植入、单独手术或 EBRT。预计该研究将有助于医生和患者为新诊断为前列腺癌的男性选择治疗方法。
