Fontanella Paolo, Benecchi Luigi, Grasso Angelica, Patel Vipul, Albala David, Abbou Claude, Porpiglia Francesco, Sandri Marco, Rocco Bernardo, Bianchi Giampaolo
Department of Surgery, Regional Hospital of Mendrisio, Mendrisio, Switzerland.
Department of Urology, Cremona Hospitals, Cremona, Italy.
Minerva Urol Nefrol. 2017 Dec;69(6):556-566. doi: 10.23736/S0393-2249.17.02832-6. Epub 2017 Mar 30.
Prostate cancer (PCa) is the most common solid neoplasm and the second leading cause of cancer death in men. After the Partin tables were developed, a number of predictive and prognostic tools became available for risk stratification. These tools have allowed the urologist to better characterize this disease and lead to more confident treatment decisions for patients. The purpose of this study is to critically review the decision-making tools currently available to the urologist, from the moment when PCa is first diagnosed until patients experience metastatic progression and death.
A systematic and critical analysis through Medline, EMBASE, Scopus and Web of Science databases was carried out in February 2016 as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted using the following key words: "prostate cancer," "prediction tools," "nomograms."
Seventy-two studies were identified in the literature search. We summarized the results into six sections: Tools for prediction of life expectancy (before treatment), Tools for prediction of pathological stage (before treatment), Tools for prediction of survival and cancer-specific mortality (before/after treatment), Tools for prediction of biochemical recurrence (before/after treatment), Tools for prediction of metastatic progression (after treatment) and in the last section biomarkers and genomics.
The management of PCa patients requires a tailored approach to deliver a truly personalized treatment. The currently available tools are of great help in helping the urologist in the decision-making process. These tests perform very well in high-grade and low-grade disease, while for intermediate-grade disease further research is needed. Newly discovered markers, genomic tests, and advances in imaging acquisition through mpMRI will help in instilling confidence that the appropriate treatments are being offered to patients with prostate cancer.
前列腺癌（PCa）是男性中最常见的实体肿瘤，也是癌症死亡的第二大主要原因。在Partin表格问世后，出现了许多用于风险分层的预测和预后工具。这些工具使泌尿外科医生能够更好地对这种疾病进行特征描述，并为患者做出更有信心的治疗决策。本研究的目的是对泌尿外科医生目前可用的决策工具进行批判性综述，涵盖从PCa首次诊断直至患者出现转移进展和死亡的整个过程。
2016年2月，根据系统评价和Meta分析的首选报告项目（PRISMA）声明，通过Medline、EMBASE、Scopus和科学网数据库进行了系统且批判性的分析。搜索使用了以下关键词：“前列腺癌”、“预测工具”、“列线图”。
在文献检索中识别出72项研究。我们将结果总结为六个部分：预期寿命预测工具（治疗前）、病理分期预测工具（治疗前）、生存和癌症特异性死亡率预测工具（治疗前/后）、生化复发预测工具（治疗前/后）、转移进展预测工具（治疗后），最后一部分是生物标志物和基因组学。
PCa患者的管理需要一种量身定制的方法来提供真正个性化的治疗。目前可用的工具在帮助泌尿外科医生进行决策过程中非常有帮助。这些测试在高分级和低分级疾病中表现良好，而对于中分级疾病还需要进一步研究。新发现的标志物、基因组测试以及通过多参数磁共振成像（mpMRI）在成像采集方面的进展，将有助于增强信心，确保为前列腺癌患者提供适当的治疗。
