Collins Katrina, Cheng Liang
Department of Pathology, Indiana University, Indianapolis, IN 46202, USA.
Department of Pathology, Indiana University, Indianapolis, IN 46202, USA.
Hum Pathol. 2023 Mar;133:92-101. doi: 10.1016/j.humpath.2023.02.007. Epub 2023 Mar 8.
A wide range of treatment options are available to patients with prostate cancer. Some treatments are standard (currently used) while some are emerging therapies. Androgen deprivation therapy is typically reserved for localized or metastatic prostate cancer not amenable to surgery. Radiation therapy may be offered to individuals for local therapy with curative intent in low- or intermediate-risk disease that may have a high probability of progression on active surveillance or where surgery is not suitable. Focal therapy/ablation treatment is an alternative approach for those who prefer to avoid radical prostatectomy for localized disease of low- or intermediate-risk or as salvage therapy after failed radiation therapy. Chemotherapy and immunotherapy remain under investigation and are currently used for androgen-independent disease or hormone-refractory prostate cancer; however, a better understanding of therapeutic efficacy is needed. Histopathologic changes observed in benign and malignant prostate tissue induced by hormonal therapies and radiation therapy are well described, whereas treatment-related effects secondary to novel therapies continue to be documented although their clinical significance is not absolutely clear. An informed and accurate evaluation of post-treatment prostate specimens requires pathologists with diagnostic acumen and knowledge relating to the histopathologic spectrum associated with each treatment option. In situations when clinical history is lacking, but morphologic features are suggestive of prior treatment, pathologists are encouraged to consult clinical colleagues regarding prior treatment history including details of when treatment was initiated and duration of therapy. This review aims to provide a concise update of current and emerging therapies for prostate cancer, histologic alterations and recommendations on Gleason grading.
前列腺癌患者有多种治疗选择。有些治疗是标准治疗（目前正在使用），而有些则是新兴疗法。雄激素剥夺疗法通常用于不适合手术的局限性或转移性前列腺癌。对于低风险或中风险疾病，若主动监测时有高进展概率或手术不适用，可对患者进行放射治疗以达到局部治疗并治愈的目的。对于那些因低风险或中风险局限性疾病而不愿接受根治性前列腺切除术的患者，或作为放射治疗失败后的挽救疗法，聚焦治疗/消融治疗是一种替代方法。化疗和免疫疗法仍在研究中，目前用于雄激素非依赖性疾病或激素难治性前列腺癌；然而，需要更好地了解其治疗效果。激素疗法和放射疗法在良性和恶性前列腺组织中引起的组织病理学变化已有详细描述，而新型疗法继发的治疗相关效应仍在记录中，尽管其临床意义尚不完全明确。对治疗后的前列腺标本进行明智而准确的评估需要病理学家具备诊断敏锐度以及与每种治疗选择相关的组织病理学谱知识。在缺乏临床病史但形态学特征提示曾接受治疗的情况下，鼓励病理学家就既往治疗史咨询临床同事，包括治疗开始时间和治疗持续时间等细节。本综述旨在简要介绍前列腺癌的当前和新兴疗法、组织学改变以及关于 Gleason 分级的建议。
