2014年前列腺癌指南修订要点及意义

Revision and significance of the guidelines on prostate cancer in 2014

2014年美国泌尿外科协会（AUA）、欧洲泌尿外科协会（EAU）、美国国家综合癌症网络（NCCN）、中国泌尿外科协会（CUA）等都对其《前列腺癌诊疗指南》进行了修订。在诊断方面,强调了PSA筛查的缺点和直肠指诊的重要性,确认了系统性10~12针穿刺活检的＂金标准＂地位,改良了TNM分期的方法;在治疗方面,提出了＂观察＂的概念,并将多个危险分层的治疗由主动监测改为观察,扩大了前列腺癌根治术的适应证,肯定了间歇性内分泌治疗的应用,强调了内分泌治疗的代谢并发症以及监测,以及介绍了去势抵抗性前列腺癌（castration resistant prostate cancer,CRPC）治疗的新药及用法。

The guidelines on prostate cancer of American Urological Association（AUA）,European Association of Urology（EAU）,National Comprehensive Cancer Network（NCCN）and China Urological Association（CUA）were partly revised in2014.In term of diagnosis,the shortcomings of PSA screening and the importance of digital rectal examination were emphasized,the＂gold standard＂status of the 10-12-needle aspiration biopsies was confirmed,and TNM-staging method was improved.In term of treatment,the new concept-observation was proposed,active surveillance was changed as observation in multiple risk stratifications,the indications for radical prostatectomy were expanded,the intermittent endocrine therapy was affirmed,the metabolic complications and monitoring of endocrine treatment were emphasized,and the new drugs and usage for castration resistant prostate cancer（CRPC）were introduced.