Department of Urology, Kyorin University School of Medicine, Tokyo, Japan.
Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan.
Jpn J Clin Oncol. 2020 Sep 5;50(9):963-969. doi: 10.1093/jjco/hyaa105.
Radical prostatectomy and external beam radiotherapy are recognized as comparable treatment options for localized prostate cancer. Previous studies of oncological outcomes of surgery versus radiotherapy have reported their comparability or possible superiority of surgery. However, the issue of which treatment is better remains controversial. Several factors make fair comparison of their outcomes difficult: different patient backgrounds caused by selection bias, different definitions of biochemical recurrence and different complication profiles between the treatment modalities. In 2016, the first large randomized controlled trial was published, which compared radical prostatectomy, external beam radiotherapy and active monitoring in localized prostate cancer. More recently, another study has reported comparative outcomes of robot-assisted radical prostatectomy and volumetric modulated arc therapy, as the leading surgery and radiotherapy techniques, respectively. Furthermore, there has been a trend toward combining external beam radiotherapy with brachytherapy boost, especially in patients with high-risk prostate cancer. This review summarizes the updated evidence on oncological outcomes of surgery versus external beam radiotherapy for localized prostate cancer.
根治性前列腺切除术和外照射放疗被认为是局限性前列腺癌的可比较治疗选择。先前关于手术与放疗的肿瘤学结果的研究报告了手术的可比性或可能的优越性。然而，哪种治疗方法更好的问题仍然存在争议。一些因素使得对其结果进行公平比较变得困难：由于选择偏倚导致的不同患者背景、生化复发的不同定义以及治疗方式之间的不同并发症谱。2016 年，首次发表了一项大型随机对照试验，该试验比较了局限性前列腺癌中的根治性前列腺切除术、外照射放疗和主动监测。最近，另一项研究报告了机器人辅助根治性前列腺切除术和容积调强弧形治疗的比较结果，这两种技术分别是领先的手术和放疗技术。此外，外照射放疗联合近距离放疗增敏的趋势越来越明显，尤其是在高危前列腺癌患者中。这篇综述总结了局限性前列腺癌手术与外照射放疗的肿瘤学结果的最新证据。
