Locally advanced prostate cancer : definition, prognosis and treatment
Locally advanced prostate cancer : definition, prognosis and treatment
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DOI：
10.1684/bdc.2007.0367
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发表时间：
2007-07-01
影响因子：
1.2
通讯作者：
Fizazi, Karim
中科院分区：
文献类型：
--
作者：
Plantade, Anne;Massard, Christophe;Fizazi, Karim
根据d‘Amico的标准，高危局限性前列腺癌的定义要么是包膜外延伸(T3或T4)，要么是高Gleason评分(>；7)，要么是PSA高于20 ng/ml。盆腔淋巴转移也对应于局部晚期前列腺癌。被称为诺模图的统计模型已经开发出来，用于预测前列腺癌复发的可能性，也被用于定义局部晚期患者。前列腺MRI可能有助于发现包膜外延伸或精囊受累，但仍有待讨论。为了发现转移，必须进行骨扫描、腹部和盆腔CT扫描。建议进行盆腔淋巴结清扫术，以适应这些患者的治疗。无淋巴结转移的高危局限性前列腺癌的标准治疗现已明确。局部放射和长期雄激素剥夺(GnHR激动剂)的关系显示出总体生存益处(超过10%)。推荐的照射剂量为74Gy.其他问题仍在争论中：激素治疗的最佳持续时间，比卡鲁胺150 mg剂量的GnRH激动剂的使用，最佳辐射剂量。根治性前列腺切除术不再被认为是这些患者的标准治疗方法。由于对转移性患者使用化疗对总存活率有好处，在几个随机的III期研究中，化疗作为辅助或新辅助治疗的位置受到质疑。有时高危疾病是在根治性前列腺切除术后被诊断出来的。术后可进行放射治疗，以减缓临床和生化进展。在这种情况下使用比卡鲁胺150 mg也可能对无进展生存有积极影响，在有淋巴转移的情况下，去雄激素是标准治疗，总体生存受益，局部放射治疗的地点仍有争议。
According to d'Amico's criteria., high-risk localized prostate cancer are defined either by an extracapsular extension (T3 or T4), either by a high Gleason score (> 7) or a PSA rate higher than 20 ng/ml. Pelvic lymph node involvment also corresponds to locally advanced prostate cancer Statistical models called nomograms have been developed to predict the probability of prostate cancer recurrence and are also used to define locally advanced patients. Prostate MRI may help to detect an extracapsular extension or a seminal vesicles involvment but remains still discussed. A bone scan, an abdominal and pelvic CT scan have to be performed in order to detect metastases. A pelvic lymph node dissection is recommended in order to adapt the treatment of these patients. Standard treatment for high-risk localized prostate cancer without lymph node involvment is now well defined. The association of both local radiation and a long androgen deprivation (GnHR agonist) showed an overall survival benefit (more than 10%). The radiation dose of 74 Gy is recommended. Other questions are still debating : the optimal duration of the hormonotherapy, the use of the bicalutamide 150 mg instaead of GnRH agonists, the optimal radiation dose. Radical prostatectomy is no more considered as a standard treatment for these patients. Since the use of chemotherapy for metastatic patients showed a benefit in overall survival, the place of chemotherapy as adjuvant or neo-adjuvant treatment is questionned in several randomized phase III studies. Sometimes high-risk disease is diagnosed after performance of a radical prostatectomy. A postoperative radiation may he performed in order to decrease clinical and biochemical progression. The use of bicalutamide 150 mg in this situation may have a positive impact too on progression free survival, In case of lymph node involvment, androgen deprivation is the standard treatment with an overall survival benefit, The place of local radiation therapy is still debating.