EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent
EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent
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DOI：
10.1016/j.eururo.2016.08.003
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发表时间：
2017-04-01
期刊：
影响因子：
23.4
通讯作者：
Cornford, Philip
中科院分区：
文献类型：
--
作者：
Mottet, Nicolas;Bellmunt, Joaquim;Cornford, Philip
目的：总结 2016 版欧洲泌尿外科协会 (EAU) - 欧洲放射治疗和肿瘤学会 (ESTRO) - 国际老年肿瘤学会 (SIOG) 关于临床局限性前列腺癌 (PCa) 筛查、诊断和以治愈为目的的局部治疗指南。证据获取：工作小组对新数据（2013-2015）进行了文献综述。根据对证据的系统审查，更新了指南并添加了证据级别和/或推荐等级。证据综合：BRCA2 突变已被添加为早期和侵袭性疾病的危险因素。除了格里森评分外，现在还应提供 2014 年国际泌尿病理学会五级分级系统。仍然不建议进行系统筛查。相反，必须考虑经过详细讨论并考虑患者的意愿和预期寿命后的个人风险适应策略。早期前列腺特异性抗原测试、风险计算器的使用或一种有前途的生物标志物工具正在研究中，并且可能能够限制微不足道的 PCa 的过度检测。打破诊断和治疗之间的联系可能会降低过度治疗的风险。使用标准化报告的多参数磁共振成像不能取代系统活检，但它牢固地嵌套在诊断检查中，在局部分期中发挥着关键作用。主动监测始终需要与风险极低的患者进行讨论。高危疾病的手术部位和淋巴结清扫的作用以及淋巴结阳性患者的管理已经明确。使用剂量递增强度调制技术的放射治疗是一种关键的治疗方式，最近通过增加剂量以及与激素治疗相结合，结果得到了改善。中度大分割是安全有效的，但仍缺乏长期数据。近距离放射治疗代表了增加输送剂量的有效方法。局部治疗仍处于试验阶段，而冷冻手术和 HIFU 仍缺乏长期令人信服的结果。结论：局部 PCa 的诊断、分期和治疗领域的知识正在迅速发展。 2016 年 EAU-ESTRO-SIOG PCa 指南总结了最新的发现和临床实践中的使用建议。这些是欧洲放射治疗和肿瘤学会以及国际老年肿瘤学会认可的首个 PCa 指南，反映了 PCa 管理的多学科性质。完整版本可从 EAU 办公室和在线获取 (http://uroweb.org/guideline/prostate-cancer/)。 患者摘要：2016 年 EAU-STRO-IOG 前列腺癌 (PCa) 指南提供了有关临床局限性前列腺癌的诊断和治疗的最新信息。在北欧和西欧，被诊断患有 PCa 的男性人数一直在增加。这可能是由于机会性筛查的增加，但也可能涉及其他因素（例如饮食、性行为、紫外线辐射暴露少）。我们建议，潜在筛查候选人的男性应与临床医生（也包括其家人和护理人员）进行讨论，以便做出明智的决定，作为个性化风险适应方法的一部分。 (C) 2016 年欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
Objective: To present a summary of the 2016 version of the European Association of Urology (EAU) - European Society for Radiotherapy & Oncology (ESTRO) - International Society of Geriatric Oncology (SIOG) Guidelines on screening, diagnosis, and local treatment with curative intent of clinically localised prostate cancer (PCa). Evidence acquisition: The working panel performed a literature review of the new data (2013-2015). The guidelines were updated and the levels of evidence and/or grades of recommendation were added based on a systematic review of the evidence. Evidence synthesis: BRCA2 mutations have been added as risk factors for early and aggressive disease. In addition to the Gleason score, the five-tier 2014 International Society of Urological Pathology grading system should now be provided. Systematic screening is still not recommended. Instead, an individual risk-adapted strategy following a detailed discussion and taking into account the patient's wishes and life expectancy must be considered. An early prostate-specific antigen test, the use of a risk calculator, or one of the promising biomarker tools are being investigated and might be able to limit the overdetection of insignificant PCa. Breaking the link between diagnosis and treatment may lower the overtreatment risk. Multiparametric magnetic resonance imaging using standardised reporting cannot replace systematic biopsy, but robustly nested within the diagnostic work-up, it has a key role in local staging. Active surveillance always needs to be discussed with very low-risk patients. The place of surgery in high-risk disease and the role of lymph node dissection have been clarified, as well as the management of node-positive patients. Radiation therapy using dose-escalated intensity-modulated technology is a key treatment modality with recent improvement in the outcome based on increased doses as well as combination with hormonal treatment. Moderate hypofractionation is safe and effective, but longer-term data are still lacking. Brachytherapy represents an effective way to increase the delivered dose. Focal therapy remains experimental while cryosurgery and HIFU are still lacking long-term convincing results.Conclusions: The knowledge in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2016 EAU-ESTRO-SIOG Guidelines on PCa summarise the most recent findings and advice for the use in clinical practice. These are the first PCa guidelines endorsed by the European Society for Radiotherapy and Oncology and the International Society of Geriatric Oncology and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office and online (http://uroweb.org/guideline/prostate-cancer/).Patient summary: The 2016 EAU-STRO-IOG Prostate Cancer (PCa) Guidelines present updated information on the diagnosis, and treatment of clinically localised prostate cancer. In Northern and Western Europe, the number of men diagnosed with PCa has been on the rise. This may be due to an increase in opportunistic screening, but other factors may also be involved (eg, diet, sexual behaviour, low exposure to ultraviolet radiation). We propose that men who are potential candidates for screening should be engaged in a discussion with their clinician (also involving their families and caregivers) so that an informed decision may be made as part of an individualised risk-adapted approach. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.