Soulié M, Salomon L
Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
Prog Urol. 2015 Nov;25(15):1067-85. doi: 10.1016/j.purol.2015.07.007.
Review of the comparative results of different treatment strategies (surgery, radiotherapy, ultrasound, surveillance) of prostate cancer, in which the main goal is the local control and the second target is the tolerance of the side effects of those treatments.
Review of literature using Medline databases selected based on scientific relevance. Clinical keys centered on the oncological and functional outcomes of comparative series between different curative treatments.
The numerous comparative series between surgery and other therapeutic modalities are essentially retrospective with significant methodological bias that is difficult to overcome in order to formulate the optimal thesis. However, there is a clear tendency toward surgery usually with young patients who have intermediate risk tumors without important comorbidity.
In the absence of randomized comparative series with significant power, the oncological and functional results of the radical prostatectomy with or without adjuvant treatment seem at least the same, in a selected population of patients, compared with the combination of radiotherapy-hormonotherapy in terms of survival, without biochemical recurrence, disease-specific survival and overall survival, for the aggressive tumors necessitating curative local treatments.
回顾前列腺癌不同治疗策略(手术、放疗、超声、监测)的对比结果,其中主要目标是局部控制,次要目标是这些治疗副作用的耐受性。
使用基于科学相关性选择的Medline数据库进行文献回顾。临床关键指标集中于不同根治性治疗之间对比系列的肿瘤学和功能结果。
手术与其他治疗方式之间的众多对比系列本质上是回顾性的,存在显著的方法学偏差,难以克服以形成最佳论断。然而,对于通常是患有中度风险肿瘤且无重要合并症的年轻患者,明显倾向于选择手术。
在缺乏具有足够效力的随机对比系列的情况下,对于需要进行根治性局部治疗的侵袭性肿瘤,在选定的患者群体中,无论有无辅助治疗,根治性前列腺切除术的肿瘤学和功能结果在生存、无生化复发、疾病特异性生存和总生存方面,与放疗 - 激素治疗组合相比,似乎至少相同。