《肿瘤瞭望》:请您谈谈目前全球前列腺癌的发病情况及原因？

　　Manfred Wirth博士：前列腺癌的发病率在北欧国家是最高的，但也并不比比亚洲高很多。前列腺癌的发病率每年都会提高7%～10%。所以在短时间内可能造成与世界其他国家相似的发病率。这也许与营养等因素相关，但也不是很确定。

　　Dr. Wirth: The incidence of prostate cancer is highest in the northern countries of Europe， but is not too much higher than here in Asia. But the incidence here is worsening with an increase of 7-10% per year. So in a short period of time， it may end up having a similar incidence to other countries in the world. This probably has to do with nutritional factors， but we do not know for sure.

　　《肿瘤瞭望》:临床上如何确诊前列腺癌，前列腺特异抗原（PSA）发挥了怎样的作用？

　　Manfred Wirth博士：PSA不是最理想的检测指标，但是目前为止最好的癌症检测指标。德国和大部分国家的PSA上限是4 ng／ml，如果患者的PSA升高，需要做进一步检查来确定是否患有前列腺癌。对于这部分患者，活检是必要的。我们在德雷斯顿德大学运用多参数MRI进行研究，寻找显示疑似癌症的病变，然后直接对病变进行活检。除此之外，还进行系统活检以避免错过任何癌症。

　　Dr. Wirth: PSA is not an ideal test but it is the best cancer test we currently have. If PSA is elevated in patients， then we need to do further examinations. The threshold in Germany and most countries is 4ng/ml and in those patients， a biopsy is mandatory. We performed a study in our university in Dresden where we used a multiparametric MRI and looked for specific foci that appear like cancer and we biopsy those lesions directly. In addition we do a systematic biopsy so as not to miss a cancer.

　　《肿瘤瞭望》:前列腺癌治疗方案受哪些因素的影响？不同分期前列腺癌治疗存在哪些差异？

　　Manfred Wirth博士：前列腺癌有不同的种类，有些是侵袭性前列腺癌，有的不是。侵袭性低的前列腺癌可以进行主动监测。如果患者的预期自然生存时间<10年，则可进行主动监测。年龄（目前还没有确切）以及合并疾病，是影响治疗方法选择的非常重要的因素。在晚期前列腺癌中，至少对于年轻的患者，激光前列腺癌切除术是最好的治疗选择。对于高危肿瘤和局部晚期肿瘤，通过有经验的医生进行安全的激光前列腺癌切除术是可行的。如果不是有经验的手术医生，则可能会引起包括尿失禁和勃起功能障碍等并发症。

　　Dr. Wirth: There are different prostate cancers. There are very aggressive diseases and those that are not so aggressive. Those that are less aggressive can be treated with active surveillance. If the patients age is such that natural life expectancy is <10 years then we do active surveillance. Age (which is not defined yet) and comorbidity should play a role. In advanced disease， radical prostatectomy is the best treatment option， at least in young patients. For high-risk tumors and locally advanced disease， a safe radical prostatectomy is possible in experienced hands. Problems arise if it is not done by experienced surgeons and complications will arise including incontinence and erectile dysfunction.

　　《肿瘤瞭望》:请您谈谈前列腺癌内分泌治疗的相关进展?

　　Manfred Wirth博士：内分泌治疗是转移性疾病的主要治疗方法。在这些患者中，激素治疗是最好的选择。然而，现有的来自美国、英格兰、和法国的随机试验显示，至少在高危转移性疾病，患者不应该只使用内分泌治疗，而应该联合紫杉醇化疗等方法一起治疗。

　　Dr. Wirth: Endocrine treatment is a mainstay of metastatic disease. In those patients， hormone treatment is the best option. However， we now have recent data from randomized trials from the US， England and also from France， that says that， at least in high-risk metastatic disease， patients should not be treated with endocrine treatment alone but in conjunction with chemotherapy with docetaxel.

　　《肿瘤瞭望》:与开放性手术相比，腹腔镜下前列腺癌根治术有哪些优势与不足?

　　Manfred Wirth博士：传统腹腔镜下前列腺切除术与机器人辅助腹腔镜手术是不同的。在大部分欧洲国家和几乎整个美国，传统的腹腔镜下前列腺切除术已被忽略，因为其效果不如开放性手术好。然而，机器人辅助腹腔镜下前列腺切除术的相关报告显示，其在血液流失方面好于开放性手术。与开放性手术相比，在获得前列腺尖部切缘阳性可控性方面，并没有任何证明显示机器人辅助下切除会更好。对患者而言，机器人辅助手术的皮肤切口更小，可以使患者尽早返回工作岗位，这是机器人辅助腹腔镜手术独有的优势。

　　Dr. Wirth: There is a difference between laparoscopic conventional and laparoscopic robotic surgery. Conventional laparoscopic radical prostatectomy is omitted in almost all parts of Europe and almost totally in the United States， because the results are not as good as open surgery. However， robotic assisted is now taking over as the results for robotic assisted radical prostatectomy are reported to be excellent and also show good results regarding blood loss， even better than open surgery. The other positive margins of continence and potency seem to show no convincing data to be better for robotic assisted. For the patient， there is no large skin incision， so he can return to work a little earlier than with open surgery. So it has advantages but they only exist in robotic laparoscopic procedures and not conventional laparoscopy.