Beauval J-B, Mazerolles M, Salomon L, Soulié M
Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
Département d'anesthésie-réanimation, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
Prog Urol. 2015 Nov;25(15):947-65. doi: 10.1016/j.purol.2015.08.001.
To determine the tools of therapeutic decision that push towards surgical treatment in non metastatic prostate cancer eligible to local treatment. The optimized assessment of the disease and eventual comorbidities improves the selection of patients. Patient's files will be presented in the uro-oncological multidisciplinary discussions to validate the customized therapeutic approach proposed.
Literature review using Medline (National library of medicine, Pubmed) and Med Science databases based on the scientific pertinence. Research was focused on the diagnosis of prostate cancer, the evaluation of the disease and patient's characteristics, and finally the elements that are with a surgical treatment (past medical history, past surgical history, functional status, patient's comorbidities, and life expectancy).
The pretherapeutic oncologic evaluation allows to estimate the risks associated with prostate cancer; it is an essential aspect of therapeutic decision. Several clinical, biological, imaging and pathological criteria allow to guide decision-making according to tumor aggressiveness and risk of recurrence, estimating the results of the different treatments proposed. On the other hand, the evaluation of lower urinary tract symptoms, urinary continence and sexual function, the integration of anatomical data, past medical and past surgical history are all essential for the therapeutic decision, in addition to the comorbidities (Charlson, ASA, ICD). These elements should be taken all together in order to decide for a radical or conservative management of PCa, they guide decision-making in patients candidate for surgery. For example, age plays a key role in the choice of treatment, even in older men at risk of developing high-risk PCa that can affect overall survival.
The combined evaluation of the patient and disease characteristics is of utmost importance in oncology, and especially in the treatment of non-metastatic PCa. The role of the anesthesiologist in the analysis and interpretation of comorbidities remains primordial and it is essential for the selection of the right candidates for surgery after being well informed, and orienting them toward surgery in agreement with the prerogatives programs of customized care.
确定促使适合局部治疗的非转移性前列腺癌患者接受手术治疗的治疗决策工具。对疾病及可能存在的合并症进行优化评估可改善患者的选择。患者病历将在泌尿肿瘤多学科讨论中展示，以验证所提出的个体化治疗方案。
基于科学相关性，使用Medline（国立医学图书馆，PubMed）和Med Science数据库进行文献综述。研究重点为前列腺癌的诊断、疾病评估和患者特征，以及最终与手术治疗相关的因素（既往病史、既往手术史、功能状态、患者合并症和预期寿命）。
治疗前的肿瘤学评估有助于估计与前列腺癌相关的风险；这是治疗决策的一个重要方面。若干临床、生物学、影像学和病理学标准可根据肿瘤侵袭性和复发风险指导决策，评估所提议的不同治疗方法的效果。另一方面，除了合并症（Charlson、ASA、ICD）外，对下尿路症状、尿失禁和性功能的评估、解剖学数据的整合、既往病史和既往手术史对于治疗决策均至关重要。为了决定对前列腺癌采取根治性或保守性治疗，应综合考虑这些因素，它们指导手术候选患者的决策。例如，年龄在治疗选择中起关键作用，即使是有发展为可能影响总体生存的高危前列腺癌风险的老年男性也是如此。
在肿瘤学中，尤其是在非转移性前列腺癌的治疗中，对患者和疾病特征进行综合评估至关重要。麻醉医生在分析和解释合并症方面的作用仍然至关重要，对于在充分知情后选择合适的手术候选者，并根据个体化护理的优先方案引导他们接受手术而言必不可少。
