Kretschmer A, Herlemann A, Stief C G, Gratzke C
Urologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Urologe A. 2017 May;56(5):599-603. doi: 10.1007/s00120-017-0361-0.
Recent improvements in imaging diagnostics has led to a rising incidence of oligometastatic prostate cancer and, most notably, an increasing incidence of nodal-only biochemical recurrences. In this clinical setting, systemic therapy is still the treatment of choice. However, there is increasing evidence for surgical approaches in this challenging clinical setting.
In this comprehensive review article, current evidence regarding surgical approaches of primary nodal metastases, nodal-only biochemical recurrence following radical prostatectomy, and osseous metastatic prostate cancer will be discussed.
If nodal metastasis is clinically suspected, a significant survival benefit was observed in retrospective studies if radical prostatectomy and extended pelvic lymphadenectomy was performed within a multimodal therapeutic setting. Salvage lymphadenectomy as a therapeutic option for nodal-only biochemical recurrence is clinically feasible and can postpone systemic therapy significantly. However, since most patients do not have a lasting PSA response, a survival benefit of this therapeutic approach is questionable based on current evidence. Regarding osseous metastatic prostate cancer, the surgical approach has an inferior position compared to conservative management and radiotherapy.
Evidence regarding a surgical approach towards oligometastatic prostate cancer is increasing. However, current evidence is mainly based on retrospective studies that were conducted in the pre-PSMA-PET/CT era.
成像诊断技术的近期进展导致寡转移前列腺癌的发病率上升，最显著的是仅淋巴结生化复发的发病率增加。在这种临床情况下，全身治疗仍然是首选治疗方法。然而，在这种具有挑战性的临床情况下，手术方法的证据越来越多。
在这篇综述文章中，将讨论有关原发性淋巴结转移、前列腺癌根治术后仅淋巴结生化复发以及骨转移性前列腺癌手术方法的当前证据。
如果临床怀疑有淋巴结转移，在多模式治疗背景下进行前列腺癌根治术和扩大盆腔淋巴结清扫术的回顾性研究中观察到显著的生存获益。挽救性淋巴结清扫术作为仅淋巴结生化复发的一种治疗选择在临床上是可行的，并且可以显著推迟全身治疗。然而，由于大多数患者没有持久的前列腺特异性抗原（PSA）反应，基于目前的证据，这种治疗方法的生存获益值得怀疑。对于骨转移性前列腺癌，与保守治疗和放疗相比，手术方法处于劣势。
关于寡转移前列腺癌手术方法的证据越来越多。然而，目前的证据主要基于在前列腺特异性膜抗原（PSMA）-正电子发射断层扫描/计算机断层扫描（PET/CT）时代之前进行的回顾性研究。
