METHODS: A systematic literature review using the PubMed®, Embase, and Cochrane databases was conducted to identify peer-reviewed publications relevant to the use of radiotherapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed.
RESULTS: Guideline statements are provided for patient counseling, the use of radiotherapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a re-staging evaluation.
CONCLUSIONS: Physicians should offer adjuvant radiotherapy to patients with adverse pathologic findings at prostatectomy (i.e., seminal vesicle invasion, positive surgical margins, extraprostatic extension) and should offer salvage radiotherapy to patients with prostatic specific antigen or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiotherapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiotherapy as well as the potential benefits of preventing recurrence. The decision to administer radiotherapy should be made by the patient and the multi-disciplinary treatment team with full consideration of the patient\'s history, values, preferences, quality of life, and functional status. Please visit the ASTRO and AUA websites (http://www.redjournal.org/webfiles/images/journals/rob/RAP%20Guideline.pdf and http://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm) to view this guideline in its entirety, including the full literature review.
方法:使用PubMed®进行系统的文献综述,Embase,和Cochrane数据库用于确定与前列腺切除术后放疗使用相关的同行评审出版物.审查产生了294篇文章;这些出版物被用来创建基于证据的指南声明。当证据不足时,将提供额外的指导作为临床原则。
结果:为患者提供咨询指南声明,放疗在辅助和抢救环境中的使用,定义生化复发,并进行重新评估。
结论:医师应为前列腺切除术中出现不良病理结果的患者提供辅助放疗(即,精囊侵入,手术切缘阳性,前列腺外延伸),并且应为前列腺特异性抗原或前列腺切除术后局部复发的患者提供挽救性放疗,这些患者没有远处转移性疾病的证据。放射治疗的提议应在对放射治疗可能的短期和长期副作用以及预防复发的潜在益处进行深思熟虑的讨论的背景下进行。放疗的决定应由患者和多学科治疗小组在充分考虑患者病史的情况下做出。值,preferences,生活质量,和功能状态。请访问ASTRO和AUA网站(http://www.redjournal.org/webfiles/images/journals/rob/RAP%20Guideline.pdf和http://www.auanet.org/education/guidelines/radiation-after-prostatomy.cfm)以完整查看本指南,包括完整的文献综述。