Soderdahl D W, Wettlaufer J N, Corn B, Gomella L G
Urology Service, Madigan Army Medical Center, Tacoma, WA 98431, USA.
Tech Urol. 1996 Winter;2(4):194-206.
Neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy is an old concept that has recently been revisited. First described in the 1940s as a method to downstage inoperable prostate cancer prior to perineal prostatectomy. NHT fell out of favor for several reasons: the side effects of estrogen therapy, the finality of orchiectomy, improved staging methods, and newer treatment strategies for prostate cancer, including external beam and interstitial radiation therapy. Contemporary interest in NHT has resurfaced primarily due to the introduction of well-tolerated reversible androgen blockade. High cause-specific survival rates following radical prostatectomy for organ confined disease are possible, yet the disturbingly high incidence of positive margins in current radical prostatectomy series led to interest in offering NHT to patients prior to radical prostatectomy to impact on the positive margin rate. Initial nonrandomized studies showed that NHT provided a substantial decrease in prostate size and PSA level in addition to reducing positive margin rate by an uncertain mechanism. Subsequently, controlled randomized studies have been performed, the majority of which have confirmed decreased margin positivity. NHT has been incorporated successfully into external beam radiotherapy for locally advanced prostate cancer as well. Significantly improved disease control is possible when hormones are combined with radiation therapy. The favorable outcome of this radiation therapy approach has led to the approval of flutamide (Eulexin) for this indication when combined with a luteinizing hormone-releasing hormone analogue or orchiectomy. Whether these initial results will ultimately affect recurrence and survival data is unknown. This article provides a comprehensive review of the world literature on NHT: from an historical prospective to the current state of the art for both radical prostatectomy and external beam radiation therapy.
根治性前列腺切除术之前的新辅助激素治疗（NHT）是一个古老的概念，最近又被重新审视。它在20世纪40年代首次被描述为一种在会阴前列腺切除术之前降低无法手术的前列腺癌分期的方法。NHT因多种原因失宠：雌激素治疗的副作用、睾丸切除术的不可逆转性、分期方法的改进以及前列腺癌的新治疗策略，包括外照射和间质放射治疗。当代对NHT的兴趣主要由于引入了耐受性良好的可逆性雄激素阻断而重新出现。对于器官局限性疾病，根治性前列腺切除术后有较高的特定病因生存率，但目前根治性前列腺切除术系列中切缘阳性的发生率高得令人不安，这导致人们有兴趣在根治性前列腺切除术之前为患者提供NHT，以影响切缘阳性率。最初的非随机研究表明，NHT除了通过不确定的机制降低切缘阳性率外，还能使前列腺大小和PSA水平大幅降低。随后进行了对照随机研究，其中大多数证实切缘阳性率降低。NHT也已成功纳入局部晚期前列腺癌的外照射放疗中。当激素与放射治疗联合使用时，有可能显著改善疾病控制。这种放射治疗方法的良好结果已导致氟他胺（Eulexin）在与促黄体生成素释放激素类似物或睾丸切除术联合使用时被批准用于该适应症。这些初步结果最终是否会影响复发和生存数据尚不清楚。本文对世界范围内关于NHT的文献进行了全面综述：从历史角度到根治性前列腺切除术和外照射放疗的当前技术水平。
