Watson R B, Soloway M S
Department of Urology, University of Miami School of Medicine, FL 33101, USA.
Semin Urol Oncol. 1996 May;14(2 Suppl 2):48-55; discussion 55-6.
Randomized trials evaluating the use of androgen deprivation therapy (ADT) before radical prostatectomy have consistently shown significant decreases in prostate volume and in serum prostate-specific antigen (PSA) levels. All but one study have reported that hormonal pretreatment significantly reduces the incidence of positive surgical margins. However, androgen deprivation does not significantly influence seminal vesicle extension or lymph node involvement nor does it affect tumor grade. The fibrotic reactions that sometimes result from hormonal pretreatment can increase the difficulty of surgery but this has not been associated with a higher incidence of perioperative or postoperative complications. In closely monitored clinical trials, bothersome side effects of neoadjuvant hormonal therapy have been limited. Issues that remain to be addressed are the optimal duration of neoadjuvant treatment and whether the benefits of such therapy will translate into improved disease-free survival. At this time, patients with clinical stage T2b disease, PSA elevations greater than 10 to 20 ng/mL, and a high Gleason grade may be considered candidates for neoadjuvant hormonal treatment before surgery.
评估在根治性前列腺切除术之前使用雄激素剥夺疗法（ADT）的随机试验一直表明，前列腺体积和血清前列腺特异性抗原（PSA）水平显著降低。除一项研究外，所有研究均报告激素预处理可显著降低手术切缘阳性的发生率。然而，雄激素剥夺对精囊侵犯或淋巴结受累并无显著影响，也不影响肿瘤分级。激素预处理有时导致的纤维化反应会增加手术难度，但这与围手术期或术后并发症的较高发生率并无关联。在密切监测的临床试验中，新辅助激素治疗令人烦恼的副作用有限。有待解决的问题是新辅助治疗的最佳持续时间，以及这种治疗的益处是否会转化为无病生存期的改善。目前，临床分期为T2b期疾病、PSA升高超过10至20 ng/mL且Gleason分级高的患者可被视为手术前新辅助激素治疗的候选者。
