Stewart Suzanne B, Boorjian Stephen A
Department of Urology, Mayo Clinic, Roschester, MN.
Department of Urology, Mayo Clinic, Roschester, MN.
Urol Oncol. 2015 May;33(5):235-44. doi: 10.1016/j.urolonc.2014.10.003. Epub 2014 Nov 4.
Men diagnosed with high-risk prostate cancer represent the cohort of prostate cancer patients at greatest risk for subsequent disease-specific mortality. Unfortunately, however, the classification of high-risk tumors remains imprecise and heterogeneous. There has been a historical reluctance to offer such patients aggressive local treatment, and considerable debate exists regarding the optimal management in this setting.
We present here our institutional experience, as well as data from several other centers, with radical prostatectomy for high-risk tumors.
We discuss that surgery affords accurate pathological staging, thereby improving the identification of patients for secondary therapies. Moreover, prostatectomy not only provides durable local disease control but in addition numerous contemporary surgical series in high-risk patients have shown radical prostatectomy to be associated with excellent long-term cancer-specific survival. Further, although studies comparing surgical and radiotherapy modalities in high-risk prostate patients have been wrought with methodological challenges, consistently these observational studies have found equivalent to improved oncologic outcomes when surgery is utilized as the primary treatment.
Herein, we review the advantages, long-term outcomes, and technique of surgery for high-risk prostate cancer.
被诊断为高危前列腺癌的男性是前列腺癌患者中后续疾病特异性死亡风险最高的群体。然而，不幸的是，高危肿瘤的分类仍然不精确且存在异质性。历史上一直不愿意为这类患者提供积极的局部治疗，并且对于这种情况下的最佳管理存在相当大的争议。
我们在此介绍我们机构的经验，以及其他几个中心关于高危肿瘤根治性前列腺切除术的数据。
我们讨论了手术能提供准确的病理分期，从而改善对二次治疗患者的识别。此外，前列腺切除术不仅能提供持久的局部疾病控制，而且众多针对高危患者的当代手术系列研究表明，根治性前列腺切除术与优异的长期癌症特异性生存率相关。此外，尽管比较高危前列腺癌患者手术和放疗方式的研究面临诸多方法学挑战，但这些观察性研究一致发现，当手术作为主要治疗方法时，肿瘤学结局相当甚至更好。
在此，我们回顾了高危前列腺癌手术的优势、长期结局和技术。
