Chang Albert J, Autio Karen A, Roach Mack, Scher Howard I
Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, CA 94115, USA.
Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA.
Nat Rev Clin Oncol. 2014 Jun;11(6):308-23. doi: 10.1038/nrclinonc.2014.68. Epub 2014 May 20.
Approximately 15% of patients with prostate cancer are diagnosed with high-risk disease. However, the current definitions of high-risk prostate cancer include a heterogeneous group of patients with a range of prognoses. Some have the potential to progress to a lethal phenotype that can be fatal, while others can be cured with treatment of the primary tumour alone. The optimal management of this patient subgroup is evolving. A refined classification scheme is needed to enable the early and accurate identification of high-risk disease so that more-effective treatment paradigms can be developed. We discuss several principles established from clinical trials, and highlight other questions that remain unanswered. This Review critically evaluates the existing literature focused on defining the high-risk population, the management of patients with high-risk prostate cancer, and future directions to optimize care.
约15%的前列腺癌患者被诊断为高危疾病。然而，目前高危前列腺癌的定义涵盖了一群预后各异的患者。一些患者有可能进展为致命的表型，可能会致命，而另一些患者仅通过原发性肿瘤的治疗就能治愈。这一患者亚组的最佳管理方法正在不断发展。需要一种更精细的分类方案，以便能够早期准确识别高危疾病，从而制定更有效的治疗模式。我们讨论了从临床试验中确立的几个原则，并强调了其他仍未得到解答的问题。本综述批判性地评估了现有文献，这些文献聚焦于定义高危人群、高危前列腺癌患者的管理以及优化治疗的未来方向。
