Solé Balcells F J
Arch Esp Urol. 1989;42 Suppl 2:131-8.
Currently, radical prostatectomy has resurged due to techniques that permit preservation of the erector nerves and the routine use of the Walsh technique. Consequently, much interest has been focussed on methodology and technology that permit early diagnosis of prostate cancer. Until recently, patients with stage A cancer of prostate were considered to require no treatment and only regular control was recommended. Because an 18% incidence of disease progression has been demonstrated for stage A1 tumors over a period of 8 years and three quarters of the patients die from cancer, the approach has currently changed and radical prostatectomy is now recommended for relatively young patients (aged +/- 60 years). Walsh reported that more than 90% of patients with stage A1 tumors had preserved sexual potency after radical prostatectomy and 100% were completely continent. Radical surgery is evidently warranted in patients with stage A2 cancer of the prostate. The problem arises however in correctly staging the cancer in patients over 60 years and clearly establishing whether the tumor is stage A1 or A2. Surgery is not advocated for stage A1 tumors whereas radical prostatectomy is an indication for those with stage A2 tumors. The latter is an indication for repeat transurethral resection for multiple biopsy, and ultrasound-guided mapping and biopsy of the prostate. These currently depend on the preference of the physician instituting treatment.
目前，由于能够保留勃起神经的技术以及Walsh技术的常规应用，根治性前列腺切除术再度兴起。因此，人们对能够实现前列腺癌早期诊断的方法和技术极为关注。直到最近，A期前列腺癌患者还被认为无需治疗，仅建议定期检查。鉴于已证实A1期肿瘤在8年期间有18%的疾病进展发生率，且四分之三的患者死于癌症，目前治疗方法已有所改变，现在建议对相对年轻的患者（年龄约60岁）进行根治性前列腺切除术。Walsh报告称，超过90%的A1期肿瘤患者在根治性前列腺切除术后保留了性功能，100%的患者完全控尿。对于A2期前列腺癌患者，根治性手术显然是必要的。然而，问题在于如何准确对60岁以上患者的癌症进行分期，并明确肿瘤究竟是A1期还是A2期。A1期肿瘤不主张进行手术，而根治性前列腺切除术适用于A2期肿瘤患者。对于后者，需要进行重复经尿道切除术以进行多次活检，以及超声引导下的前列腺定位和活检。目前这些操作取决于实施治疗的医生的偏好。
