高危前列腺癌的的治疗策略.pdfVIP

中华临床医师杂志(电子版)2014 年 11 月第 8 卷第 21 期 Chin J Clinicians(Electronic Edition),November 1,2014,Vol.8,No.21? ·3753· ·专题笔谈· 高危前列腺癌的治疗策略 张祥华 周哲 【摘要】 既往的研究认为内分泌治疗联合放射治疗是高危前列腺癌的标准治疗方案，然而由 于缺乏随机对照研究结果的支持，没有证据表明内分泌治疗联合放射治疗的疗效优于根治性前列腺 切除。在不增加手术并发症的基础上，根治性前列腺切除能够达到对前列腺癌的局部控制，同时能 够获得前列腺癌准确的病理分期以指导进一步的治疗选择。目前的研究证实根治性前列腺切除应该 成为高危前列腺癌患者可选择的治疗方案之一，同时根治性前列腺切除或放射治疗以及辅助内分泌 治疗为核心的综合治疗是高危前列腺癌患者的主要治疗模式。? 【关键词】??前列腺肿瘤；??高危；??综合疗法? ? Treatment policy for high risk prostate cancer Zhang Xianghua, Zhou Zhe. Department of Urology, Peking University Shougang Hospital, Beijing 100144, China Corresponding author: Zhang Xianghua,Email: urozhang@ 【Abstract】 Previous studies revealed that combined androgen deprivation therapy with radiation therapy could be the standard treatment for the high risk prostate cancer, while due to absence of randomized clinical trial, there was no definite evidence to support that androgen deprivation therapy was superior to radical prostatectomy. Radical prostatectomy may lead to excellent local control of the prostate cancer without an increase in morbidity, furthermore, may provide exact pathological grade and stage of prostate cancer to guide adjuvant treatments in future. Based on the present studies, radical prostatectomy should be the one selection, in addition, combined treatment of radical prostatectomy or radiation therapy with androgen deprivation therapy can become the main modality for the treatment of high risk prostate cancer. 【Key words】 Prostatic neoplasms; High risk; Combined modality therapy ?长期以来，泌尿外科医生对于前列腺癌的治疗 合放射治疗比根治性前列腺切除更有优势[2]。 选择主要依据肿瘤的临床分期（TNM 分期）、血清 近年来随着微创外科的兴起以及腹腔镜技术 前列腺特异抗原（prostate specific antigen，PSA） 的普及，越来越多的高危前列腺癌患者接受了腹腔 水平以及前列腺穿刺病理的 Gleason 评分等结果进 镜根