目的:欧洲泌尿外科协会(EAU)-欧洲核医学协会(EANM)-欧洲放射治疗和肿瘤学会(ESTRO)-欧洲泌尿生殖放射学学会(ESUR)-国际泌尿病理学学会(ISUP)-国际老年肿瘤学会(SIOG)指南为临床上局部前列腺癌(PCa)的管理提供了建议。本文旨在介绍EAU-EANM-ESTRO-ESUR-ISUP-SIOG筛查指南的2024版摘要,诊断,和临床局部PCa的治疗。
方法:小组对所有以英文发布的新数据进行了文献综述,涵盖2020年5月至2023年的时间框架。准则更新了,并根据对证据的系统评价,为每项建议添加强度评级.
■建议一种风险适应策略,用于识别可能患有PCa的男性,通常从50岁开始,基于个性化的预期寿命。建议使用多参数磁共振成像以避免不必要的活检。当考虑活检时,应联合进行靶向性和区域性活检.前列腺特异性膜抗原正电子发射断层扫描成像是识别转移扩散的最敏感技术。主动监测是对低风险PCa男性的适当管理,以及国际泌尿外科病理学学会第2级病变的选定中危患者。解决了当地的治疗方法,以及手术后持久性前列腺特异性抗原的管理。建议在中等风险患者中考虑低分割。应该为患有cN1PCa的患者提供局部治疗,并长期加强激素治疗。
结论:诊断领域的证据,分期,局部PCa的治疗正在迅速发展。这些PCa指南反映了PCa管理的多学科性质。
结果:本文是“可治愈”前列腺癌指南的摘要。前列腺癌是通过多步基于风险的筛查过程“发现”的。我们的目标是找到尽可能多的男性可以治愈的癌症。前列腺癌是可以治愈的,如果它位于前列腺;然后它被分类为低,中介-,和高风险的局部和局部晚期前列腺癌。这些风险等级是治疗的基础。低危前列腺癌接受“积极监测”治疗,预后良好的治疗方法。对于低中介风险的主动监督也应作为一种选择进行讨论。在其他情况下,积极治疗,手术,或放射治疗应与潜在的副作用一起讨论,以允许共同决策。
OBJECTIVE: The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG)
guidelines provide recommendations for the management of clinically localised prostate cancer (PCa). This paper aims to present a summary of the 2024 version of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG
guidelines on the screening, diagnosis, and treatment of clinically localised PCa.
METHODS: The panel performed a literature review of all new data published in English, covering the time frame between May 2020 and 2023. The
guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence.
UNASSIGNED: A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for selected favourable intermediate-risk patients with International Society of Urological Pathology grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term intensified hormonal treatment.
CONCLUSIONS: The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa
guidelines reflect the multidisciplinary nature of PCa management.
RESULTS: This article is the summary of the
guidelines for \"curable\" prostate cancer. Prostate cancer is \"found\" through a multistep risk-based screening process. The objective is to find as many men as possible with a curable cancer. Prostate cancer is curable if it resides in the prostate; it is then classified into low-, intermediary-, and high-risk localised and locally advanced prostate cancer. These risk classes are the basis of the treatments. Low-risk prostate cancer is treated with \"active surveillance\", a treatment with excellent prognosis. For low-intermediary-risk active surveillance should also be discussed as an option. In other cases, active treatments, surgery, or radiation treatment should be discussed along with the potential side effects to allow shared decision-making.