Ebert T
Urologische Klinik, Heinrich-Heine-Universität, Düsseldorf.
Praxis (Bern 1994). 1997 Nov 12;86(46):1815-8.
The concept of using endocrine therapy to shrink the prostate or its cancer preoperatively has the aim to make the cancer more amenable to complete resection by radical prostatovesiculectomy. Four large prospective, randomized phase-II-studies are published which studied the effect of neoadjuvant antiandrogenic treatment in comparison with a control without hormonal therapy. The results of these contemporary series are: 1. reduction in prostate volume, 2. significantly lower PSA-values at the time of surgery, 3. a decreased rate of positive surgical margins in patients with cT2-tumors. However, the neoadjuvant treatment does reduce neither the incidence of seminal vesical nor of lymph node involvement. Although the results of pathologic downstaging in T2-tumors are encouraging, long-term follow-up to monitor disease-free survival and overall survival is required to document the true benefit of the approach. Possible disadvantages are 1. the cost factor, 2. the side effects of treatment, 3. the delay of definitive treatment especially in case of tumor cell clones not sensitive to the hormonal approach.
术前使用内分泌疗法缩小前列腺或其癌灶的理念旨在使癌症更易于通过根治性前列腺精囊切除术完全切除。已发表了四项大型前瞻性随机II期研究，这些研究对比了新辅助抗雄激素治疗与无激素治疗对照组的效果。这些当代系列研究的结果如下：1. 前列腺体积减小；2. 手术时PSA值显著降低；3. cT2期肿瘤患者手术切缘阳性率降低。然而，新辅助治疗既未降低精囊受累率，也未降低淋巴结受累率。尽管T2期肿瘤病理降期的结果令人鼓舞，但仍需要长期随访以监测无病生存期和总生存期，以证明该方法的真正益处。可能的缺点包括：1. 成本因素；2. 治疗的副作用；3. 确定性治疗的延迟，尤其是在肿瘤细胞克隆对激素疗法不敏感的情况下。
