2021版欧洲泌尿外科学会前列腺癌诊疗指南更新要点解读

<正>前列腺癌（prostate cancer,PCa）的发病率在男性肿瘤中居第二位,近年来我国PCa发病率呈上升趋势。目前PCa的诊断和治疗已形成较为统一的共识,2021版欧洲泌尿外科学会（European Association ofUrology,EAU）PCa诊疗指南在2020年的基础上进行了更新。本文旨在对2021版指南更新内容要点进行解读,为国内泌尿外科工作者提供参考。     

2020年版欧洲泌尿外科学会前列腺癌指南更新要点及解读

自从欧洲泌尿外科学会（EAU）发布2019年版前列腺癌（PCa）指南以来,又出现了许多新的证据,尤其是在筛查、影像学检查及晚期肿瘤新型治疗方面有所突破。因此,EAU修订了该指南并发布了2020年版PCa指南。新指南在筛查和早期诊断、危险分层、前列腺穿刺、影像学检查手段、转移性PCa的治疗、去势抵抗性PCa的治疗、PCa根治性切除术等方面具有重大更新。本文解读了该指南的更新要点,希望能对我国泌尿外科医生的诊疗工作提供参考。     

欧洲泌尿学会更新前列腺癌诊疗指南

欧洲泌尿学会(EAU)的首个前列腺癌(CaP)诊疗指南于2001年发表。在过去的几年里,每当出现影响CaP临床治疗的重要变革时,EAU都会对指南进行更新。2005年8月,EAU再次更新了CaP诊疗指南。从www.uroweb.org网站上可以获得新指南的完整版本。工作小组对新数据进行文献回顾,并按循证医学(EBM)原则,插入了证据水平和推荐分级,以便读者更好地理解推荐资料的质量。下面就指南中CaP的危险因素、CaP的筛查、CaP的诊断与分期方法和CaP的治疗原则部分分别进行介绍。1CaP的危险因素这次更新的指南指出,遗传因素在临床确定前列腺癌患病危险时是…     

2020版EAU前列腺癌指南更新解读之四

辅助治疗是对根治性前列腺切除术的补充,旨在降低复发的风险,主要包括辅助雄激素剥夺治疗、辅助放疗和辅助化疗。2020版欧洲泌尿外科学会(EAU)前列腺癌指南新增了一项根治性前列腺切除术后辅助外放疗随机对照研究的结果,强调辅助放疗对于高风险患者的重要性;对盆腔淋巴结转移者(pN1期)新增推荐了辅助雄激素剥夺治疗联合辅助放疗时应对盆腔淋巴结和前列腺窝进行照射。     

欧洲泌尿外科学会射精功能障碍诊疗指南

欧洲泌尿外科学会（European Assocation of Urology，EAU）射精功能障碍诊疗指南由Colpi（意大利）、Weidner（德国）、Jungwirth（奥地利）、Pomerol（西班牙）、Papp（匈牙利）、Hargreave（英国）、Dohle（荷兰）共同起草制定，发表在欧洲泌尿外科杂志2004年第46卷第5期上。     

2022欧洲泌尿外科学会指南：尿石症手术干预治疗的最佳实践解读

<正>泌尿系结石发病率逐年升高^[1],为社会带来沉重经济负担。目前,尿石症主要手术治疗方式包括体外冲击波碎石(SWL)、软/硬输尿管镜(URS/RIRS)、经皮肾镜碎石取石术(PCNL)及腹腔镜/机器人手术取石。近年来,随着输尿管镜及PCNL设备微型化、高功率钬激光、铥激光及一次性输尿管软镜的推广应用,尿石症外科治疗有了显著发展。目前,尿石症外科治疗中部分领域仍存在争议。本文对EAU2022年尿石症手术干预治疗最佳临床实践的指南部分进行解读。     

2018版欧洲泌尿外科前列腺癌指南要点解读

正欧洲泌尿外科前列腺癌指南自2001年开始出第一版,最近几年每年欧洲泌尿外科年会均会更新一版。欧洲泌尿外科学会(European Association of Urology,EAU)指南之所以能成为最受欢迎的指南之一,最主要的原因是其具备如下特点:(1)体现多学科综合意见,欧洲泌尿外科前列腺癌指南编写团队既有泌尿外科专家,也包括了放疗、生殖、病理,以及患者代表,最大程度地体现了多学科综合意见;(2)以患者为中心,在指南的开     

局限高危前列腺癌患者接受全雄激素阻断联合近距离治疗后的PSA变化模式与其生存预后的临床关联分析

目的:探讨前列腺癌(PCa)患者治疗后PSA变化模式对其生存预后的临床影响。方法:回顾性总结近12年来114例接受全雄激素阻断(MAB)联合近距离治疗的PCa患者的临床资料,从PSA变化规律入手,初步分析患者生存预后的影响因素。结果:患者中位生存时间81(15~144)个月,1、3、5年生存率分别为91.23%、78.07%和68.42%。单因素分析显示:基线PSA水平、PSA最低值、PSA下降时间、PSA倍增时间以及PSA缓解幅度均是可能影响生存预后的临床因素。多因素分析显示:PSA最低值、PSA下降时间以及PSA缓解幅度是独立的预后因素,并分别提高了患者远期生存可能1.7、3.3和6.8倍。结论:局限高危PCa患者在接受MAB联合近距离治疗后,其PSA能否降至1μg/L以下、能否在3个月之内降至最低值,以及PSA最大缓解幅度能否达到96%等因素均是影响患者预后的独立风险因素。     

Updated Japanese Urological Association Guidelines on prostate‐specific antigen‐based screening for prostate cancer in 2010

The exposure rate of screening for prostate cancer using prostate‐specific antigen (PSA) in Japan is still very low compared with that in the USA or western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8‐fold higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death. PSA screening, which can reduce the risk of death as a result of prostate cancer, should be offered to all men at risk of developing prostate cancer with fact sheets showing updated benefits and drawbacks of screening for prostate cancer.     

Congress of the American Urological Association (AUA): update on prostate cancer

At the last congress of the American Urological Association (AUA), which took place in San Francisco from the 9th to the 12th May 2004, more than 200 abstracts on prostate cancer were presented as posters or as full communications. We present here the highlights of this congress and in particular the main subjects of news, controversies or innovations. Two major topics are particularly worthy of discussion: localized disease on the one hand and locally advanced or metastatic disease on the other. In the chapter on localized disease, we expound the most relevant data on epidemiology, screening, staging and prognosis. For the locally advanced disease we discuss quality of life, prognostic factors and recent advances in hormone therapy and chemotherapy.     

Association of obesity with tumor characteristics and treatment failure of prostate cancer in African-American and European American men

PURPOSE: The impact of body mass index on tumor characteristics and treatment failure in prostate cancer is not well understood in diverse ethnic groups. We evaluated the effect of body mass index in African-American and European American patients from a radical prostatectomy cohort between 1995 and 2004 with regard to tumor histopathological characteristics and biochemical relapse-free survival. MATERIALS AND METHODS: A total of 924 patients were studied to evaluate whether obese men (body mass index greater than 30) had different preoperative and postoperative tumor characteristics or biochemical relapse-free survival compared to nonobese men. There were 784 European American and 140 African-American patients analyzed using failure time models, adjusted for age, preoperative prostate specific antigen, tumor stage and race. RESULTS: Mean and median followup was 42 and 36 months, respectively. African-American men were significantly more obese than European American men. Mean body mass index was 29.0 in African-American and 28.1 in European American men (p = 0.003). African-American men (OR 2.30, 95% CI 1.04-5.1) were more likely to have higher tumor stage on final pathology. Obesity was a risk factor for biochemical failure in African-American men (adjusted hazard ratio 5.49, 95% CI 2.16-13.9) but not in European American men (HR 1.41, 95% CI 0.96-2.08), and this difference was statistically significant (p value for interaction 0.036). CONCLUSIONS: Obesity is associated with poorer tumor prognostic characteristics and decreased biochemical relapse-free survival, particularly in African-American men. These data suggest that obesity may in part explain the poorer prostate cancer prognosis seen in African-American men compared to other racial and ethnic groups.