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首页> 外文期刊>Nature reviews. Urology >The status of surgery in the management of high-risk prostate cancer
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The status of surgery in the management of high-risk prostate cancer

机译：手术在高危前列腺癌管理中的地位

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Although the optimal treatment for patients with high-risk prostate cancer remains unclear, combined radiotherapy and androgen-deprivation therapy (ADT) has become the standard of care; however, more recently, this paradigm has been challenged. In contemporary surgical series, using a multimodal approach with primary radical prostatectomy and adjuvant radiotherapy, when appropriate, had comparable efficacy in patients with high-risk disease to radiotherapy in combination with ADT. Furthermore, perioperative and postoperative morbidity associated with radical prostatectomy seem to be similar in patients with low-risk, intermediate-risk, or high-risk prostate cancer. Importantly, downstaging and downgrading of a substantial proportion of tumours after surgery suggests that many patients might be overtreated using radiotherapy and ADT. Indeed, the potential benefits of surgery include the ability to obtain tissues that can provide accurate histopathological information and, therefore, guide further disease management, in addition to local control of disease, a potentially reduced risk of developing metastases, and avoidance of long-term ADT. Thus, patients with high-risk disease should be offered a choice of first-line treatments, including surgery. However, effective management of high-risk prostate cancer is likely to require a multimodal approach, including surgery, radiotherapy, and neoadjuvant and adjuvant ADT, although the optimal protocols remain to be determined.
机译：尽管尚不清楚高危前列腺癌患者的最佳治疗方法，但放疗和雄激素剥夺疗法（ADT）的联合治疗已成为标准治疗方法。然而，最近，这种范例受到了挑战。在当代外科手术系列中，在适当的情况下，采用多模式方法进行原发性前列腺癌根治术和辅助放疗，与放疗联合ADT相比，在高危患者中具有可比的疗效。此外，在患有低危，中危或高危前列腺癌的患者中，与根治性前列腺切除术相关的围手术期和术后发病率似乎相似。重要的是，手术后相当一部分肿瘤的降级和降级提示许多患者可能会接受放疗和ADT过度治疗。的确，手术的潜在好处包括能够获得能够提供准确的组织病理学信息的组织的能力，因此，除了对疾病进行局部控制之外，还可以指导进一步的疾病管理，潜在地降低发生转移的风险以及避免长期使用ADT。因此，应为高危疾病患者提供包括外科手术在内的一线治疗选择。但是，对高​​危前列腺癌的有效治疗可能需要采取多种方式，包括手术，放疗以及新辅助和辅助ADT，尽管尚需确定最佳方案。

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