T3期前列腺癌不适合根治术.ppt

T3期前列腺癌适合前列腺癌根治术吗?NO 中国医科大学附属第一医院 宫大鑫 Radical prostatectomy was described by Young in 1905 for the treatment of localized prostate cancer. Dr Patrick Walsh reviewing the role of radical prostatectomy in the cure of prostate cancer。 ‘if the tumour is of a high grade, it is unlikely that cure can be achieved with any form of treatment’. Walsh PC. Radical prostatectomy for the treatment localised prostate cancer.Urol Clin North Am 1980; 7: 583. cT3前列腺癌现状 cT3前列腺癌约占15%。 cT3手术切缘阳性率达56%。 cT3淋巴结转移率达27-50%。 Even in carefully selected patients with small T3 cancers, seminal vesicle invasion is present in 67% and lymph node metastases in 20%. Ohori M et al Cancer 1994c;73:104–114.  cT3肿瘤采用根治性前列腺切除术状况 美国Chicago 新诊断的cT1–2 期前列腺癌30%采用RP. 有较长预期寿命年轻病人也只有约67%采用RP. 只用6%cT3前列腺癌采用RP。 美国 Mayo clinic 1983年采用RP比例为25.3% 2001年降为2.8%。 Meltzer D,Patterns of prostate cancer treatment by clinical stage and age.Am J Public Health，2001;91: 126–8 Ward JF.Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int. 2005 Apr;95(6):751-6. cT3实际情况 术前能准确分期吗？ DRE常常低估肿瘤的进展情况。 一项研究表明DRE阳性情况和肿瘤分期符合度小于 50% 。 约 60% 的pT3在术前不能被TRUS 检测到。 区分 T2和 T3不能单纯依靠TRUS。 PSA和临床分期也没有直接联系。 EAU guideline of prostate cancer.2007 RP的目的 In men with localized CaP and a life expectancy of 10 years or more, the goal of a radical prostatectomy by any approach must be eradication of the disease . The success of radical prostatectomy for clinical stage T3 prostate cancer relies on the removal of all local tumor-bearing tissue. Huland H. Scientific Communication International, Jersey,Channel Islands, 1997, pp. 227-257. Guidelines on Prostate Cancer(EAU,2007） Campbells Urology, 8th ed 反对对T3行RP的主要原因 生存率 淋巴结转移 切缘阳性率 生活质量 生存率-T3N0前列腺癌自然病史 美国退伍军人管理协会泌尿外科协作研究组数据： 5年生存率50%,10年生存率20%。（接受了一定程度的内分泌治疗） Adolfsson报道： 共55例，分化良好前列腺癌。5年生存率88%，9年生存率70%。 Adolfsson J. Deferred treatment of low grade stage T3 prostate cancer without distant metastase