The management of high-risk prostate cancer in 2008.

摘要

Significant advances have occurred in the last decade in defining more precisely the risk of prostate cancer. Clinical parameters based on Gleason score of the biopsy as well as serum PSA and clinical staging have been used to define the risk of cancer death in people managed conservatively as well as the risk of mortality following treatment with radiotherapy or radical prostatectomy. Peter Albertsen, who has made landmark contributions to the field of risk assessment, is presenting in this issue the results of his population-based studies assessing cancer risk and relative efficacy of surgery over radiation therapy. The use of surgery, however, has been limited particularly in North America where the philosophy during the last decade was more to select the optimal patient for better treatment success. Cooperberg et al. provide a remarkable analysis of the trends in the management of high-risk prostate cancer in the United States from 1990 to 2007 based on the CAPSURE database. Their study does not provide evidence for a meaningful downward risk migration among the high-risk patients over the past 15 years and suggest that some men in this category may be under-treated. The group at Memorial Sloan-Kettering Cancer Center has explored the use of curative treatment in an attempt to make "treatment possible in those for whom it is necessary", that is patients with high-risk of mortality by prostate cancer. Yossepowitch and Eastham are providing an extensive review of the resultsobtained with radical prostatectomy for high-risk prostate cancer patients.