Motterle Giovanni, Ahmed Mohamed E, Andrews Jack R, Karnes R Jeffrey
Department of Urology, Mayo Clinic, Rochester, MN, United States.
Department of Surgery, Oncology and Gastroenterology-Urology, Padova, Italy.
Front Oncol. 2019 Dec 10;9:1395. doi: 10.3389/fonc.2019.01395. eCollection 2019.
Patients diagnosed with clinically node-positive prostate cancer represent a population that has historically been thought to harbor systemic disease. Increasing evidence supports the role of local therapies in advanced disease, but few studies have focused on this particular population. In this review we discuss the limited role for conventional cross sectional imaging for accurate nodal staging and how molecular imaging, although early results are promising, is still far from widespread clinical utilization. To date, evidence regarding the role of radical prostatectomy and pelvic lymph node dissection in clinically node-positive disease comes from retrospective studies; overall surgery appears to be a reasonable option in selected patients, with improved oncological outcomes that could be attributed to both to its potential curative role in disease localized to the pelvis and to the improved staging to help guide subsequent multimodal treatment. The role of surgery in clinically node-positive disease needs higher-level evidence but meanwhile, radical prostatectomy with extended pelvic lymph-node dissection can be offered as a part of a multimodality approach with the patient.
被诊断为临床淋巴结阳性前列腺癌的患者群体，历来被认为存在全身性疾病。越来越多的证据支持局部治疗在晚期疾病中的作用，但很少有研究关注这一特定人群。在本综述中，我们讨论了传统横断面成像在准确淋巴结分期方面的有限作用，以及分子成像尽管早期结果很有前景，但仍远未广泛应用于临床。迄今为止，关于根治性前列腺切除术和盆腔淋巴结清扫术在临床淋巴结阳性疾病中的作用的证据来自回顾性研究；总体而言，手术似乎是部分患者的合理选择，其肿瘤学结局的改善可能归因于其对局限于盆腔疾病的潜在治愈作用以及有助于指导后续多模式治疗的改善分期。手术在临床淋巴结阳性疾病中的作用需要更高水平的证据，但与此同时，根治性前列腺切除术联合扩大盆腔淋巴结清扫术可作为与患者多模式治疗方法的一部分。
