Herlemann Annika, Washington Samuel L, Eapen Renu S, Cooperberg Matthew R
Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA; Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA.
Urol Clin North Am. 2017 Nov;44(4):547-555. doi: 10.1016/j.ucl.2017.07.003.
Management of prostate cancer presents unique challenges because of the disease's variable natural history. Accurate risk stratification at the time of diagnosis in clinically localized disease is crucial in providing optimal counseling about management options. To accurately distinguish pathologically indolent tumors from aggressive disease, risk groups are no longer sufficient. Rather, multivariable prognostic models reflecting the complete information known at time of diagnosis offer improved accuracy and interpretability. After diagnosis, further testing with genomic assays or other biomarkers improves risk classification. These postdiagnostic risk assessment tools should not supplant shared decision making, but rather facilitate risk classification and enable more individualized care.
前列腺癌的管理面临着独特的挑战，因为该疾病的自然病程具有变异性。在临床局限性疾病诊断时进行准确的风险分层，对于提供关于管理选项的最佳咨询至关重要。为了准确区分病理上惰性的肿瘤和侵袭性疾病，风险分组已不再足够。相反，反映诊断时已知完整信息的多变量预后模型提供了更高的准确性和可解释性。诊断后，通过基因组检测或其他生物标志物进行进一步检测可改善风险分类。这些诊断后的风险评估工具不应取代共同决策，而应促进风险分类并实现更个性化的护理。
