Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
Eur Urol Oncol. 2020 Jun;3(3):270-280. doi: 10.1016/j.euo.2020.03.002. Epub 2020 Apr 14.
Intermediate-risk prostate cancer consists of a highly heterogeneous group of patients. Owing to this heterogeneity and variable prognoses, it is challenging to provide uniform treatment recommendations for men in this group.
To review the current literature regarding the best available evidence for stratification and treatment of intermediate-risk prostate cancer patients.
We searched Medline and EMBASE, through September 2019 without year or language restriction, supplemented with hand search.
Different treatment options with good long-term oncological outcomes are available for intermediate-risk prostate cancer patients. Best available evidence with long follow-up exists for radical prostatectomy and dose-escalated radiotherapy with short-term androgen deprivation. In favorable intermediate-risk patients, active surveillance and brachy-monotherapy also represent two valid treatment options. In carefully selected men, partial gland ablation represents a reasonable option. Patient preferences and comorbidities should also be considered.
Treatment options for intermediate-risk patients range from active surveillance to partial gland ablation, radical prostatectomy, and various radiotherapy methods. The best stratification and the optimal treatment remain controversial. Classification systems, such as the National Cancer Comprehensive Network guidelines, stratify this large cohort into subgroups with favorable or unfavorable disease, which may simplify treatment recommendations but still leave substantial variability within strata. Advanced imaging may further improve current stratification systems of intermediate-risk patients.
In this review, we assessed the current literature regarding the best available evidence for stratification and treatment of intermediate-risk prostate cancer patients.
中危前列腺癌由一组高度异质性的患者组成。由于这种异质性和不同的预后，为该组男性提供统一的治疗建议具有挑战性。
回顾目前关于中危前列腺癌患者分层和治疗的最佳可用证据的文献。
我们检索了 Medline 和 EMBASE，截至 2019 年 9 月，没有年限或语言限制，并辅以手工搜索。
中危前列腺癌患者有多种治疗选择，长期肿瘤学结果良好。根治性前列腺切除术和短期雄激素剥夺剂量递增放疗具有长期随访的最佳可用证据。在有利的中危患者中，主动监测和近距离单药治疗也是两种有效的治疗选择。在精心挑选的男性中，部分腺体消融术是一种合理的选择。患者的偏好和合并症也应考虑在内。
中危患者的治疗选择范围从主动监测到部分腺体消融术、根治性前列腺切除术和各种放疗方法。最佳分层和最佳治疗仍存在争议。分类系统，如国家癌症综合网络指南，将这个大队列分为疾病预后良好或不良的亚组，这可能简化治疗建议，但在亚组内仍存在很大的变异性。先进的影像学可能进一步改善中危患者的现有分层系统。
在这篇综述中，我们评估了目前关于中危前列腺癌患者分层和治疗的最佳可用证据的文献。
