Garnick M B, Fair W R
Beth Israel Hospital, Boston, Massachusetts, USA.
Ann Intern Med. 1996 Aug 1;125(3):205-12. doi: 10.7326/0003-4819-125-3-199608010-00009.
To review important topics related to prostate cancer that have arisen since this subject was last covered in Annals in 1993. The review consists of two parts. Part II describes neoadjuvant hormonal therapy, new local treatment options (including three-dimensional conformal radiation therapy, brachytherapy, and cryosurgery), antiandrogen therapy management of erectile dysfunction, funding and legislation for research, and areas for future research, especially in genetics investigations.
Randomized studies identified through a MEDLINE search (1992 to 1996); large, single-institutional conferences and consortiums; and studies presented at regional, national, and international symposia.
Qualitative and quantitative data are reported. Part II describes results of completed randomized trials that used neoadjuvant hormonal therapy. Studies have shown that nearly 50% more patients with cT2 disease will have pathologically confined (pT2) prostate cancer as a result of preoperative neoadjuvant hormonal therapy. Time to development of progressive disease and disease-free survival are improved in patients receiving neoadjuvant hormonal therapy before radiation therapy, but the long-term overall effects on survival of neoadjuvant therapy before surgery or radiation are unknown. Other methods for treating localized prostate cancer (three-dimensional conformal radiation therapy, brachytherapy, and cryotherapy) are gaining popularity, despite the lack of long-term efficacy results. Advances in the understanding of the optimal use of antiandrogens and managing treatment-induced erectile dysfunction continue to benefit patients with prostate cancer.
Prostate cancer is being detected with increasing frequency, and many patients are receiving such treatments as radical prostatectomy and radiation therapy. Although refinements in prostate-specific antigen (PSA)-based testing have contributed substantially to the increased rate of detection of prostate cancer, the incidence of disease was increasing dramatically even before PSA detection was possible. Despite earlier detection, the optimal therapy for the early form of the disease is still enigmatic. Further studies and longer follow-up of patients who participated in completed studies are needed to better define the outcomes and importance of prostate cancer therapies. More research is needed to help elucidate the reasons for the increased incidence of the disease; such efforts should help define strategies to ultimately prevent prostate cancer.
回顾自1993年《 Annals》上次报道前列腺癌相关主题以来出现的重要话题。本综述分为两部分。第二部分描述了新辅助激素治疗、新的局部治疗选择（包括三维适形放射治疗、近距离放射治疗和冷冻手术）、抗雄激素治疗对勃起功能障碍的管理、研究的资金和立法，以及未来研究领域，特别是遗传学研究。
通过MEDLINE检索（1992年至1996年）确定的随机研究；大型单机构会议和联盟；以及在地区、国家和国际研讨会上发表的研究。
报告了定性和定量数据。第二部分描述了使用新辅助激素治疗的已完成随机试验的结果。研究表明，由于术前新辅助激素治疗，cT2期疾病患者中病理局限（pT2）前列腺癌的患者几乎多了50%。在放疗前接受新辅助激素治疗的患者中，疾病进展时间和无病生存期得到改善，但手术或放疗前新辅助治疗对生存的长期总体影响尚不清楚。尽管缺乏长期疗效结果，但其他治疗局限性前列腺癌的方法（三维适形放射治疗、近距离放射治疗和冷冻治疗）越来越受欢迎。对抗雄激素的最佳使用和治疗引起的勃起功能障碍的管理的认识进展继续使前列腺癌患者受益。
前列腺癌的检出频率越来越高，许多患者正在接受根治性前列腺切除术和放射治疗等治疗。尽管基于前列腺特异性抗原（PSA）检测的改进对前列腺癌检出率的提高有很大贡献，但甚至在PSA检测成为可能之前，该疾病的发病率就已急剧上升。尽管检测较早，但该疾病早期形式的最佳治疗方法仍然不明。需要对参与已完成研究的患者进行进一步研究和更长时间的随访，以更好地确定前列腺癌治疗的结果和重要性。需要更多研究来帮助阐明该疾病发病率增加的原因；这些努力应有助于确定最终预防前列腺癌的策略。
