Perez C A, Michalski J, Lockett M A
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
Mo Med. 1995 Nov;92(11):696-704.
Optimal treatment for patients with localized carcinoma of prostate is controversial. Radiation therapy is an established modality; reports indicate that results are comparable to those of radical prostatectomy. A retrospective review was carried out of 963 patients with carcinoma of the prostate treated with definitive irradiation (65 to 71 Gy in 6.5 to 7 weeks). Survival, incidence of local recurrence and distant metastases, and postirradiation PSA data were analyzed. Ten-year disease-free survival with external irradiation was 100% for clinical stage A1 (T1a), 69% for stage A2 (T1b,c), 57% for clinical stage B (T2), and 41% for stage C (T3). Initial PSA level closely correlated with probability of freedom from chemical failure (PSA elevation) after definitive irradiation in 317 patients with stage T1b,c and T2 tumors (96% and 89%, respectively, with initial PSA of < 10 ng/ml and 75% and 65% with higher PSA levels). Although modern irradiation techniques produce results comparable to those of radical prostatectomy in localized prostate carcinoma, we must continue to critically assess treatment policies, develop appropriately designed prospective clinical trials, and define optimal management of these patients.
局限性前列腺癌患者的最佳治疗方法存在争议。放射治疗是一种既定的治疗方式；报告表明其结果与根治性前列腺切除术相当。对963例接受根治性放疗（6.5至7周内给予65至71 Gy）的前列腺癌患者进行了回顾性研究。分析了生存率、局部复发和远处转移的发生率以及放疗后的前列腺特异性抗原（PSA）数据。临床分期为A1（T1a）的患者接受外照射后的10年无病生存率为100%，A2期（T1b、c）为69%，临床分期为B期（T2）为57%，C期（T3）为41%。在317例T1b、c期和T2期肿瘤患者中，初始PSA水平与根治性放疗后免于生化失败（PSA升高）的概率密切相关（初始PSA<10 ng/ml时分别为96%和89%，PSA水平较高时分别为75%和65%）。尽管现代放疗技术在局限性前列腺癌中产生的结果与根治性前列腺切除术相当，但我们必须继续严格评估治疗策略，开展设计合理的前瞻性临床试验，并确定这些患者的最佳管理方案。
