摘要：局限性前列腺癌是临床上最为常见的疾病阶段，规范及优化疾病的诊疗有望提升患者的预后及生活质量。 2022年 7月，美国泌尿外科学会 （American Urological Association，AUA） 联合美国放射肿瘤学会 （American Society for Radiation Oncology，ASTRO） 共同发布了新一版临床局限性前列腺癌诊疗指南，主要包括风险评 估、疾病分期、基于风险的处理、处理原则以及治疗后随访五个方面，本文对其推荐内容、强度和证据等级等进 行归纳，并结合我国前列腺癌诊疗情况加以讨论和分析。

 

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高旭.《2022 AUA/ASTRO 临床局限性前列腺癌指南》 要点解析[J]. 泌尿外科杂志（电子版）,2022,14(4):24-30. DOI:10.20020/j.CNKI.1674-7410.2022.04.06

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对于泌尿外科医生而言，在前列腺癌的诊疗工 作中，临床局限性前列腺癌的风险评估、诊疗决策 及随访管理占有非常的重要地位。2017 年，美国 泌 尿外科学会 （American Urological Association， AUA） 曾联合美国放射肿瘤学会 （American Society for Radiation Oncology，ASTRO） 及泌尿肿瘤 学会 （Society of Urologic Oncology，CUO） 共同 发布过临床局限性前列腺癌的诊疗指南[1-2] 。时隔 5 年，AUA 再次联合 ASTRO，共同发布了该指南 的 2022 版本[3-5] 。该指南分为风险评估、疾病分期、 基于风险的处理、处理原则以及治疗后随访等五个 部分，以 44 条配有证据等级及推荐强度的建议陈 述的形式，涵盖了局限性前列腺癌临床诊疗决策中 的绝大多数场景。该指南编写小组成立于 2019 年， 通过对大量相关文献进行系统评价等方法，得出指 南最终的建议内容，其中有大量详细解释及荟萃分 析结果的内容，限于篇幅只能以“补充材料”的形 式发布在 AUA 网站[6] 。本文摘录指南中的相关陈 述，并结合我国前列腺癌诊治现状及临床实践加以解读。

1 风险评估

2 疾病分期

3 基于风险的处理

4 处理原则
    4.1 主动监测的原则
    4.2 根治手术的原则
    4.3 放射治疗的原则

5 治疗后随访

6 小结

6 小结 

此次 AUA 联合 ASTRO 发布的 2022 版本临床 局限性前列腺癌诊疗指南，较上一版本更贴近临床 应用。在临床应用过程中需注意，指南中部分推荐 性陈述可能与我国临床诊疗场景不符，或其推荐依 据源于西方人临床研究数据，应结合具体实际加以 甄别使用。

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