盘点：近期前列腺癌重要指南及共识汇总

2016-10-08 MedSci MedSci原创

前列腺癌是当前威胁全世界男性健康的主要恶性肿瘤之一，在欧美国家，其发病率已连续多年居男性恶性肿瘤发病率首位，死亡率居第二位。我国前列腺癌发病率虽低于欧美国家，但随着我国人口老龄化和饮食结构的改变，近年来也呈逐年上升趋势。这里梅斯小编整理了近期关于前列腺癌的重要指南及共识。【1】2016 循证建议：雄激素阻断疗法治疗局限性和晚期前列腺癌前列腺癌的管理仍然在不断演变，雄激素阻断疗法是一个已经确立的

前列腺癌是当前威胁全世界男性健康的主要恶性肿瘤之一，在欧美国家，其发病率已连续多年居男性恶性肿瘤发病率首位，死亡率居第二位。我国前列腺癌发病率虽低于欧美国家，但随着我国人口老龄化和饮食结构的改变，近年来也呈逐年上升趋势。这里梅斯小编整理了近期关于前列腺癌的重要指南及共识。

【1】2016 循证建议：雄激素阻断疗法治疗局限性和晚期前列腺癌

前列腺癌的管理仍然在不断演变，雄激素阻断疗法是一个已经确立的治疗方法选择，尤其是针对转移性疾病的患者。本文的主要目的是回顾雄激素阻断疗法的相关证据，为男性前列腺癌的治疗及其在争议领域的应用提供建议。（文章详见——2016 循证建议：雄激素阻断疗法治疗局限性和晚期前列腺癌）

【2】2016 EAU/ESTRO/SIOG指南：前列腺癌指南-第1部分：筛查，诊断，局部治疗

2016年8月，欧洲泌尿外科学会(EAU)、欧洲放射肿瘤学学会(ESTRO)、国际老年肿瘤学会(SIOG)共同发布了前列腺癌指南，本文为该指南的第一部分，只要内容涉及临床局部前列腺癌的筛查，诊断以及局部治疗。（文章详见——2016 EAU/ESTRO/SIOG指南：前列腺癌指南-第1部分：筛查，诊断，局部治疗）

【3】2016 EAU/ESTRO/SIOG指南：前列腺癌-第2部分：恶化，转移以及去势抵抗性前列腺癌的治疗

2016年8月，欧洲泌尿外科学会(EAU)、欧洲放射肿瘤学学会(ESTRO)、国际老年肿瘤学会(SIOG)共同发布了前列腺癌指南，本文为该指南的第2部分，主要内容涉及恶化，转移以及去势抵抗性前列腺癌的治疗。（文章详见——2016 EAU/ESTRO/SIOG指南：前列腺癌-第2部分：恶化，转移以及去势抵抗性前列腺癌的治疗）

【4】2016 前列腺穿刺中国专家共识

为普及穿刺活检知识、规范临床操作，提高我国前列腺癌早期诊断整体水平，中华医学会泌尿外科学分会和中国前列腺癌联盟专家组结合各国指南及此领域热点问题、相关文献，编制此共识。（文章详见——2016 前列腺穿刺中国专家共识）

【5】2016 中国前列腺癌药物去势治疗专家共识

随着对前列腺癌生物学特性的深入认识，前列腺癌的治疗手段也在不断更新、演化。最早Hunter发现，切除双侧睾丸的男性前列腺会发生萎缩；之后于1941年，Huggins和Hodges发现前列腺癌存在激素依赖性，降低雄激素水平和／或阻断雄激素受体可以抑制前列腺癌的生长，临床上将抑制睾丸雄激素分泌或抑制雄激素活性的治疗方法统称为雄激素去除治疗，即为前列腺癌的内分泌治疗。ADT包括去势治疗和抗雄治疗。其中，去势治疗又分为手术去势和药物去势。去势治疗是目前治疗进展性前列腺癌和转移性前列腺癌的标准治疗方式。对去势治疗无效的前列腺癌，定义为去势抵抗性的前列腺癌。

为促进国内泌尿外科同道更加科学、规范地进行前列腺癌的药物去势治疗，中国前列腺癌联盟专家在结合国内外文献及指南的基础上，讨论制定了“中国前列腺癌药物去势治疗的专家共识”，以供国内泌尿外科医师参考。本共识中“前列腺癌药物去势治疗”适应证主要包括局限性前列腺癌、进展性前列腺癌和转移性前列腺癌。（文章详见——2016 中国前列腺癌药物去势治疗专家共识）

【6】2016 NCCN肿瘤临床实践指南：前列腺癌（2016年第2版）

《NCCN前列腺癌指南》从2016年第1版更新至2016年第2版的更新内容包括：

1.动态监测，新增以下条目：“如果PSA的增加和系统前列腺活检阴性时怀疑前位和/或侵袭性癌，可考虑mpMRI。”

2.对讨论章节进行了更新，以反映算法方面的改变。（文章详见——2016 NCCN肿瘤临床实践指南：前列腺癌（2016年第2版））

【7】2016 NCCN临床实践指南：前列腺癌（2016.V3）

2016年5月，美国国家综合癌症网络(NCCN)发布前列腺癌指南2016年第3版，指南更新摘要如下：

初始前列腺癌诊断

非常低风险：初始治疗、辅助治疗

低风险：初始治疗、辅助治疗

中间风险：初始治疗、辅助治疗

高风险，极高风险：初始治疗、辅助治疗

检测，复发

前列腺切除术失败

放射治疗复发

系统治疗

随后系统治疗

生存寿命评估原则

影像检查原则

积极监测和观察原则

放射治疗原则

手术治疗原则

雄激素剥夺疗法的原则

免疫治疗和化疗的原则

分期（文章详见——2016 NCCN临床实践指南：前列腺癌（2016.V3））

【8】2016 NCCN临床实践指南：前列腺癌早期检测（2016.V2）

2016年4月，美国国家综合癌症网络(NCCN)发布了前列腺癌早期检测指南2016年第2版，指南更新摘要如下：

简介

基线评估,风险评估和早期检测评估

活组织检查适应症

活组织检查结果的管理（文章详见——2016 NCCN临床实践指南：前列腺癌早期检测（2016.V2））

【9】2016AUA/SAR共识声明——先前活检阴性患者前列腺MRI检查和MRI定向活检发布

2016年6月，美国泌尿外科学会(AUA)联合腹部放射学会(SAR)前列腺癌工作组共同发布了先前活检阴性患者前列腺MRI检查和MRI定向活检共识，初始活检阴性的患者需要改善重复活检的患者选择以及重复活检的诊断率，该共识声明主要针对先前活检阴性患者进行前列腺MRI检查和MRI定向活检提出了质量保证的具体建议。（文章详见—2016AUA/SAR共识声明——先前活检阴性患者前列腺MRI检查和MRI定向活检发布）

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2017-01-27 yangcx0915

#期前列腺癌#

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2016-10-11 1e10c84am36(暂无匿称)

好文章，受益

71 0
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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sun Oct 09 09:59:32 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142557, encodeId=689a14255ea2, content=谢谢分享！, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sun Oct 09 09:59:27 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142463, encodeId=6091142463a1, content=学习了，呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5d591737749, createdName=1df0137fm56(暂无匿称), createdTime=Sun Oct 09 08:57:25 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142451, encodeId=9a7014245190, content=前列腺癌治疗上难度很大, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Sun Oct 09 07:45:56 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142432, encodeId=c1481424321b, content=学习了谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Sun Oct 09 06:56:58 CST 2016, time=2016-10-09, status=1, ipAttribution=)]
2016-10-10 1e10c84am36(暂无匿称)

文章很好，继续关注

55 0
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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Sun Oct 09 06:56:58 CST 2016, time=2016-10-09, status=1, ipAttribution=)]
2016-10-09 知难而进

继续关注！

63 0
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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Sun Oct 09 06:56:58 CST 2016, time=2016-10-09, status=1, ipAttribution=)]
2016-10-09 知难而进

谢谢分享！

62 0
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2016-10-09 1df0137fm56(暂无匿称)

学习了，呀

48 0
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2016-10-09 雅文博武

前列腺癌治疗上难度很大

29 0
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2016-10-09 刘煜

学习了谢谢。

17 0
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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Sun Oct 09 06:56:58 CST 2016, time=2016-10-09, status=1, ipAttribution=)]
2016-10-09 医路开来

学习啦，，

21 0
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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sun Oct 09 09:59:32 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142557, encodeId=689a14255ea2, content=谢谢分享！, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sun Oct 09 09:59:27 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142463, encodeId=6091142463a1, content=学习了，呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5d591737749, createdName=1df0137fm56(暂无匿称), createdTime=Sun Oct 09 08:57:25 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142451, encodeId=9a7014245190, content=前列腺癌治疗上难度很大, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Sun Oct 09 07:45:56 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142432, encodeId=c1481424321b, content=学习了谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Oct 09 07:08:51 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142384, encodeId=83f1142384d7, content=学习啦，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Sun Oct 09 06:57:04 CST 2016, time=2016-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=142383, encodeId=249b142383d5, content=谢谢分享，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Sun Oct 09 06:56:58 CST 2016, time=2016-10-09, status=1, ipAttribution=)]
2016-10-09 医路开来

谢谢分享，，

27 0