Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza, Suite B265, Los Angeles, CA, 90095, USA.
Department of Radiation Oncology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, USA.
Curr Oncol Rep. 2023 Mar;25(3):221-229. doi: 10.1007/s11912-023-01374-9. Epub 2023 Feb 1.
Multimodality therapy including radical prostatectomy, radiation therapy, and hormone therapy are frequently deployed in the management of localized prostate cancer. We sought to perform a critical appraisal of the most contemporary literature focusing on the multimodality management of localized prostate cancer.
Men who are ideal candidates for multimodality therapy include those with unfavorable intermediate-risk disease, high-risk disease, and very high-risk disease. Enhancements in both systemic agents (including second-generation antiandrogens) as well as localized therapies (such as stereotactic body radiotherapy and brachytherapy) are refining the optimal balance between the use of systemic and local therapies for localized prostate cancer. Genomic predictors are emerging as critical tools for more precisely allocating treatment intensification with multimodality therapies as well as treatment de-intensification. Close collaboration among medical oncologists, surgeons, and radiation oncologists will be critical for coordinating evidence-based multimodality therapies when clearly indicated and for supporting shared decision-making in areas where the evidence is mixed.
根治性前列腺切除术、放射治疗和激素治疗等多种治疗方法常被用于局限性前列腺癌的治疗。我们旨在批判性地评估聚焦于局限性前列腺癌的多种治疗方法的最新文献。
适合多种治疗方法的理想患者包括中危疾病、高危疾病和极高危疾病患者。全身性药物（包括第二代抗雄激素药物）和局部治疗方法（如立体定向体部放射治疗和近距离放射治疗）的改进，正在完善局部前列腺癌的全身性和局部治疗方法的最佳平衡。基因组预测因子正成为更精确地分配强化多种治疗方法以及减轻治疗强度的关键工具。当明确需要多种治疗方法时，肿瘤内科医生、外科医生和放射肿瘤学家之间的密切合作对于协调基于证据的多种治疗方法以及在证据存在分歧的领域支持共同决策至关重要。
