AUA前列腺癌介绍课件.ppt

2010年美国泌尿外科年会前列腺癌相关进展 北京大学第三医院泌尿外科 刘磊 马潞林 关于前列腺癌的文献 数量多，分类细 临床随访数量多，资料翔实 涉及的领域比较广泛 问题1 前列腺癌根治术（RP）、前列腺癌外放射治疗（EBRT）、前列腺癌近距离照射治疗（brachytherapy）这三种方法治疗效果的比较？ 问题1 10,472 patients with localized prostate cancer at Cleveland Clinic and Barnes-Jewish Hospital. radical prostatectomy (N=6493) EBRT (N=2260) brachytherapy (N=1719) 285 OVERALL AND CANCER SPECIFIC URVIVAL FOLLOWING DEFINITIVE THERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER IN THE PROSTATE-SPECIFIC ANTIGEN ERA 问题1 EBRT and brachytherapy were significantly associated with diminished survival (HR 1.6 [95% CI: 1.4-1.9] and 1.7 [95% CI: 1.4-2.1], respectively; P 0.001)compared to radical prostatectomy after adjusting for biopsy Gleason score, PSA, age, comorbidity, ethnicity, and clinical stage. 问题1 EBRT and brachytherapy were also associated with a significantly higher rate of androgen-deprivation therapy (P 0.001). Compared to radical prostatectomy, a trend towards higher cancer-specific mortality was observed for EBRT (adjusted HR 1.6; 95% CI: 1.0-2.6), but not for brachytherapy (adjusted HR 1.1; 95% CI: 0.5, 2.6) 问题1 After adjusting for the most relevant disease-specific and patient-specific confounders, radical prostatectomy is associated with improved intermediate-term survival compared to EBRT and brachytherapy. Physicians and patients should consider these potential survival differences when choosing among treatment options for localized prostate cancer. 问题2 前列腺癌淋巴结清扫的范围？ 问题2 Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) provides accurate staging and may be therapeutic, since 10-20% of men with LN metastases (+LN) live 10 years with an undetectable PSA after RP+PLND alone. However, the extent of PLND remains controversial. 问题2 Using a full PLND (external iliac, EI; obturator, O; and hypogastric, H), Studer reported that only 37% of patients with +LN would be identified if PLND was restricted to the EI area above the obturator nerve (the typical limited PLND perfo