The very-high-risk prostate cancer: a contemporary update.
The very-high-risk prostate cancer: a contemporary update.
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DOI：
10.1038/pcan.2016.40
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发表时间：
2016-12
影响因子：
4.8
通讯作者：
Yossepowitch O
中科院分区：
文献类型：
--
作者：
Mano R;Eastham J;Yossepowitch O
在过去的二十年中，高危前列腺癌的治疗已经有了很大的发展，但具有非常高风险特征的患者尽管进行了积极的治疗，仍可能出现不良结局。我们回顾了当代文献，重点是目前的定义，现代成像和治疗方法在极高危前列腺癌的作用。我们使用以下检索词检索了MEDLINE数据库中2000 - 2016年期间以英文发表的所有临床试验或实践指南：“前列腺肿瘤”（MeSH术语）和（“高风险”（关键词）或“局部晚期”（关键词）或“淋巴结阳性”（关键词））。对与极高危前列腺癌相关的摘要进行了评价，并将40项相关研究作为本综述的基础。“非常”高危前列腺癌一词仍然定义不清。EAU和NCCN指南提供了唯一可用的定义，将临床分期为T3-4或淋巴结受累最小的患者归类为极高风险，而不考虑PSA水平或活检Gleason评分。mpMRI和PET-PSMA扫描的现代成像在治疗前评估中发挥作用。几项随机临床试验支持通过外照射联合雄激素剥夺的局部确定性治疗，而手术在极高风险环境中的作用联合辅助放疗/雄激素剥夺治疗正在出现。越来越多的证据表明，在多模式方法的背景下，新辅助紫杉烷化疗可能是有益的。具有非常高风险肿瘤的男性可能受益于多模式方案中的局部确定性治疗，在精心选择的患者中提供局部控制和可能的治愈。进一步的研究是必要的，以更好地描述“非常”的高风险类别，并确定最佳的治疗方案，为个别患者。
Treatment of high-risk prostate cancer has evolved considerably over the past two decades, yet patients with very high-risk features may still experience poor outcome despite aggressive therapy. We review the contemporary literature focusing on current definitions, role of modern imaging and treatment alternatives in very high-risk prostate cancer. We searched the MEDLINE database for all clinical trials or practice guidelines published in English between 2000 – 2016 with the following search terms: ‘prostatic neoplasms’ (MeSH Terms) AND (‘high risk’ (keyword) OR ‘locally advanced’ (keyword) OR ‘node positive’ (keyword)). Abstracts pertaining to very high-risk prostate cancer were evaluated and 40 pertinent studies served as the basis for this review. The term ‘very’ high-risk prostate cancer remains ill defined. The EAU and NCCN guidelines provide the only available definitions, categorizing those with clinical stage T3-4 or minimal nodal involvement as very-high risk irrespective of PSA level or biopsy Gleason score. Modern imaging with mpMRI and PET-PSMA scans plays a role in pretreatment assessment. Local definitive therapy by external beam radiation combined with androgen deprivation is supported by several randomized clinical trials whereas the role of surgery in the very high-risk setting combined with adjuvant radiation/ androgen deprivation therapy is emerging. Growing evidence suggest neoadjuvant taxane based chemotherapy in the context of a multimodal approach may be beneficial. Men with very high-risk tumors may benefit from local definitive treatment in the setting of a multimodal regimen, offering local control and possibly cure in well selected patients. Further studies are necessary to better characterize the ‘very’ high-risk category and determine the optimal therapy for the individual patient.
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影响因子：
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通讯作者：
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