【AUA指南】临床局限性前列腺癌(Clinically localized prostate cancer)
SHARED DECISION MAKING (SDM)
共享决策（SDM）
1. Counseling of patients to select a management strategy for localized prostate cancer should incorporate shared decision making and explicitly consider cancer severity (risk category), patient values and preferences, life expectancy, pre-treatment general functional and genitourinary symptoms, expected post-treatment functional status, and potential for salvage treatment. (Strong Recommendation; Evidence Level: Grade A)
1. 关于局限性前列腺癌管理策略的患者指导，应整合共同决策和明确考虑癌症严重程度（风险分级）、患者价值观和内心倾向、预期寿命、治疗前基础状况与泌尿系症状、治疗后预期基础状况以及潜在挽救治疗方案。（强烈建议；证据水平：A级）
2. Prostate cancer patients should be counseled regarding the importance of modifiable health-related behaviors or risk factors, such as smoking and obesity. (Expert Opinion)
2. 建议前列腺癌患者重视可调节的健康相关习惯或危险因素，如吸烟和肥胖。（专家意见）
3. Clinicians should encourage patients to meet with different prostate cancer care specialists (e.g., urology and either radiation oncology or medical oncology or both), when possible to promote informed decision making. (Moderate Recommendation; Evidence Level: Grade B)
3. 如果对患者的知情决策有利，临床医师应鼓励患者就诊于不同专业方向的前列腺癌治疗专家（如泌尿专家、肿瘤放疗专家、肿瘤内科专家）。（中等程度建议；证据水平：B级）
4. Effective shared decision making in prostate cancer care requires clinicians to inform patients about immediate and long-term morbidity or side effects of proposed treatment or care options. (Clinical Principle)
4. 制定有效的前列腺共同决策时，临床医生需告知患者推荐治疗或护理方案的当前及长期发病率或副作用。（临床诊疗原则）
CARE OPTIONS BY CANCER SEVERITY/RISK GROUP
Very Low-/Low-Risk Disease
肿瘤严重程度/风险组的护理选择
极低/低风险疾病
5. Clinicians should inform patients about suitable clinical trials and encourage patients to consider participation in such trials based on eligibility and access. (Expert Opinion)
5. 临床医师应告知患者适合的临床试验，并鼓励患者参加符合自身条件的临床试验。（专家意见）
6. Clinicians should not perform abdomino-pelvic CT or routine bone scans in the staging of asymptomatic very lowor low-risk localized prostate cancer patients. (Strong Recommendation; Evidence Level: Grade C)
6. 无症状的极低危、低危的局灶性前列腺癌患者分期时不必行腹部-盆腔CT或常规骨扫描。（强烈建议；证据水平：C级）
7. Clinicians should recommend active surveillance as the best available care option for very low-risk localized prostate cancer patients. (Strong Recommendation; Evidence Level: Grade A)
7. 极低危的局灶性前列腺癌患者的最佳方案为主动监测。（强烈建议；证据水平：A级）
8. Clinicians should recommend active surveillance as the preferable care option for most low-risk localized prostate cancer patients. (Moderate Recommendation; Evidence Level: Grade B)
8. 大部分低危局灶性前列腺癌患者的首选方案为主动监测。（中等程度建议；证据水平：B级）
9. Clinicians may offer definitive treatment (i.e. radical prostatectomy or radiotherapy) to select low-risk localized prostate cancer patients who may have a high probability of progression on active surveillance. (Conditional Recommendation; Evidence Level: Grade B)
9. 主动监测中出现高度可能性进展的低危前列腺癌患者可给与干预（如前列腺癌根治性切除、或放疗）。（一定前提条件下的建议；证据水平：B级）
10. Clinicians should not add ADT along with radiotherapy for low-risk localized prostate cancer with the exception of reducing the size of the prostate for brachytherapy. (Strong Recommendation; Evidence Level: Grade B)
10. 低危局限性前列腺癌，在放疗前无需行以缩小前列腺体积为目的的内分泌治疗。（强烈建议；证据水平：B级）
11. Clinicians should inform low-risk prostate cancer patients considering whole gland cryosurgery that consequent side effects are considerable and survival benefit has not been shown in comparison to active surveillance. (Conditional Recommendation; Evidence Level: Grade C)
11. 当低危前列腺患者考虑前列腺冷冻治疗时，临床医生应告知其此术式有显著副作用，与主动监测相比无生存获益。（一定前提条件下的建议；证据水平：C级）
12. Clinicians should inform low-risk prostate cancer patients who are considering focal therapy or high intensity focused ultrasound (HIFU) that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion)
12. 当低危前列腺癌患者考虑行局部治疗或高能聚焦超声治疗（海扶刀），临床医生应告知因缺乏对照证据此术式非标准治疗方案。（专家意见）
13. Clinicians should recommend observation or watchful waiting for men with a life expectancy ≤5 years with lowrisk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade B)
13. 对于预期寿命≤5年的低危局灶性前列腺癌患者，建议观察或随访。（强烈建议；证据水平：B级）
14. Among most low-risk localized prostate cancer patients, tissue based genomic biomarkers have not shown a clear role in the selection of candidates for active surveillance. (Expert Opinion)
14. 对于大部分低危局灶性前列腺癌患者来说，组织基础的遗传学生物标志物检测对于主动监测患者的筛选方面并无明确作用。（专家意见）
Intermediate-Risk Disease
中危肿瘤
15. Clinicians should consider staging unfavorable intermediate-risk localized prostate cancer patients with cross sectional imaging (CT or MRI) and bone scan. (Expert Opinion)
15. 对于分期不明确的中危局灶性前列腺癌患者，应行横断面影像学检查（CT或MRI）及骨扫描。（专家意见）
16. Clinicians should recommend radical prostatectomy or radiotherapy plus androgen deprivation therapy (ADT) as standard treatment options for patients with intermediate-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)
16. 对于中危的局灶性前列腺癌患者，建议进行前列腺癌根治性切除术或放疗辅助内分泌治疗作为标准方案。（强烈建议；证据水平：A级）
17. Clinicians should inform patients that favorable intermediate-risk prostate cancer can be treated with radiation alone, but that the evidence basis is less robust than for combining radiotherapy with ADT. (Moderate Recommendation; Evidence Level: Grade B)
17. 对于预后良好的中危局灶性前列腺癌患者来说，可仅进行放射治疗，但这方面的相关证据相比放疗联合雄激素去势治疗的证据来说不是很确切。（中等程度建议；证据水平：B级）
18. In select patients with intermediate-risk localized prostate cancer, clinicians may consider other treatment options such as cryosurgery. (Conditional Recommendation; Evidence Level: Grade C)
18. 对于特定中危的局灶性前列腺癌患者来说，可考虑其他治疗措施，如冷冻治疗。（一定前提条件下的建议；证据水平：C级）
19. Active surveillance may be offered to select patients with favorable intermediate-risk localized prostate cancer; however, patients should be informed that this comes with a higher risk of developing metastases compared to definitive treatment. (Conditional Recommendation; Evidence Level: Grade C)
19. 对于特定预后良好组的中危局灶性前列腺癌患者来说，也可进行主动监测；但应告知患者主动监测相比治疗干预，有较高的转移风险。（一定前提条件下的建议；证据水平：C级）
20. Clinicians should recommend observation or watchful waiting for men with a life expectancy ≤5 years with intermediate-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)
20. 对于预期寿命≤5年的中危局灶性前列腺癌患者来说，建议观察或随访。（强烈建议；证据水平：A级）
21. Clinicians should inform intermediate-risk prostate cancer patients who are considering focal therapy or HIFU that these interventions are not standard care options 21. because comparative outcome evidence is lacking. (Expert Opinion)
21. 中危前列腺癌患者考虑局部治疗或高能聚焦超声治疗时，临床医生应告知因缺乏对照证据此术式非标准治疗方案。（专家意见）
High-Risk Disease
高危肿瘤
22. Clinicians should stage high-risk localized prostate cancer patients with cross sectional imaging (CT or MRI) and bone scan. (Clinical Principle)
22. 高危前列腺癌患者应行横断面影像学检查（CT或MRI）及骨扫描以明确分期。（临床原则）
23. Clinicians should recommend radical prostatectomy or radiotherapy plus ADT as standard treatment options for patients with high-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)
23. 高危局灶性前列腺癌患者，应行前列腺癌根治性切除术或放疗，辅助内分泌治疗作为标准方案。（强烈建议；证据水平：A级）
24. Clinicians should not recommend active surveillance for patients with high-risk localized prostate cancer. Watchful waiting should only be considered in asymptomatic men with limited life expectancy (≤5 years). (Moderate Recommendation; Evidence Level: Grade C)
24. 高危局灶性前列腺癌患者，不建议主动监测；只有对预期寿命有限（≤5年）的无症状患者方可考虑等待观察。（中等程度建议；证据水平：C级）
25. Cryosurgery, focal therapy and HIFU treatments are not recommended for men with high-risk localized prostate cancer outside of a clinical trial. (Expert Opinion)
25. 高风险局灶性前列腺癌患者除临床试验外，不建议进行冷冻治疗、局部治疗及高能聚焦超声治疗。（专家意见）
26. Clinicians should not recommend primary ADT for patients with high-risk localized prostate cancer unless the patient has both limited life expectancy and local symptoms. (Strong Recommendation; Evidence Level: Grade A)
26. 高风险局灶性前列腺癌患者不推荐内分泌治疗为主要治疗方案，除非预期寿命有限且出现局部症状。（强烈建议；证据水平：A级）
27. Clinicians may consider referral for genetic counseling for patients (and their families) with high-risk localized prostate cancer and a strong family history of specific cancers (e.g., breast, ovarian, pancreatic, other gastrointestinal tumors, lymphoma). (Expert Opinion)
27. 高危局灶性前列腺癌合并特定癌症（如乳腺癌、卵巢癌、胰腺癌、其他胃肠道肿瘤、淋巴瘤）家族史者，临床医师可考虑就患者（及其家庭成员）情况进行遗传学会诊。（专家意见）
Active Surveillance
主动监测
28. Localized prostate cancer patients who elect active surveillance should have accurate disease staging including systematic biopsy with ultrasound or MRI-guided imaging. (Clinical Principle)
28. 应对选择主动监测的局灶性前列腺癌患者采用超声引导或磁共振引导成像穿刺活检进行精确分期。（临床原则）
29. Localized prostate cancer patients undergoing active surveillance should have routine surveillance PSA testing and digital rectal exams. (Strong Recommendation; Evidence Level: Grade B)
29. 主动监测的局限前列腺癌患者应定期监测PSA及直肠指检。（强烈推荐；证据水平：B级）
30. Localized prostate cancer patients undergoing active surveillance should be encouraged to have a confirmatory biopsy within the initial two years and surveillance biopsies thereafter. (Clinical Principle)
30. 选择主动监测的局灶性前列腺癌患者，在最初的两年内应行进行确认性活检，此后应进行监测活检。（临床原则）
31. Clinicians may consider multiparametric prostate MRI as a component of active surveillance for localized prostate cancer patients. (Expert Opinion)
31. 临床医师应考虑将前列腺多参数MRI整合入局灶性前列腺癌患者随访方案中。（专家意见）
32. Tissue based genomic biomarkers have not shown a clear role in active surveillance for localized prostate cancer and are not necessary for follow up. (Expert Opinion)
32. 对于主动监测的局灶性前列腺癌患者来说，组织基础上的遗传学生物标志物检测无明确价值，随访中也无必要进行这方面检查。（专家意见）
33. Clinicians should offer definitive treatment to localized prostate cancer patients undergoing active surveillance who develop adverse reclassification. (Moderate Recommendation; Evidence Level: Grade B) Prostatectomy
33. 对主动监测期间出现不良表现的局灶性前列腺癌患者来说，临床医师应进行治疗干预。（中等程度建议；证据水平：B级）
Prostatectomy
前列腺根治术
34. Clinicians should inform localized prostate cancer patients that younger or healthier men (e.g., 10 year life expectancy) are more likely to experience cancer control benefits from prostatectomy than older men. (Strong Recommendation; Evidence Level: Grade B)
34. 年轻或健康水平较好的局灶性前列腺癌患者（如＜65岁，或预期寿命＞10年者）相比年龄较大患者，他们进行前列腺切除术对癌症的控制获益可能更高。（强烈建议；证据水平：B级）
35. Clinicians should inform localized prostate cancer patients that open and robot-assisted radical prostatectomy offer similar cancer control, continence recovery, and sexual recovery outcomes. (Moderate Recommendation; Evidence Level: Grade C)
35. 局灶性前列腺癌患者：开腹前列腺癌根治性切除术和机器人辅助下前列腺癌根治性切除术在癌症控制、后续恢复、性功能恢复预后方面情况近似。（中等程度建议；证据水平：C级）
36. Clinicians should inform localized prostate cancer patients that robotic/laparoscopic or perineal techniques are associated with less blood loss than retropupic prostatectomy. (Strong Recommendation; Evidence Level: Grade B)
36. 局灶性前列腺癌患者，在行机器人辅助或内镜下前列腺癌根治性手术时，经会阴的手术方式相比耻骨后手术方式来说出血更少。（强烈建议；证据水平：B级）
37. Clinicians should counsel localized prostate cancer patients that nerve-sparing is associated with better erectile function recovery than non-nerve sparing. (Strong Recommendation; Evidence Level: Grade A)
37. 应告知患者：保留神经的手术方案相比不保留神经来说，勃起功能恢复方面会更好。（强烈建议；证据水平：A级）
38. Clinicians should not treat localized prostate cancer patients who have elected to undergo radical prostatectomy with neoadjuvant ADT or other systemic therapy outside of clinical trials. (Strong Recommendation; Evidence Level: Grade A)
38. 除参加临床试验外，不需要对选择放疗的前列腺癌患者行新辅助内分泌治疗或其他系统治疗。（强烈建议；证据水平：A级）
39. Clinicians should inform localized prostate cancer patients considering prostatectomy, that older men experience higher rates of permanent erectile dysfunction and urinary incontinence after prostatectomy compared to younger men. (Strong Recommendation; Evidence Level: Grade B)
39. 进行前列腺切除的局灶性前列腺癌患者，高龄男性相对低龄男性，术后出现永久性勃起功能障碍及尿失禁的比例较高。（强烈建议；证据水平：B级）
40. Pelvic lymphadenectomy can be considered for any localized prostate cancer patients undergoing radical prostatectomy and is recommended for those with unfavorable intermediate-risk or high-risk disease. Patients should be counseled regarding the common complications of lymphadenectomy, including lymphocele development and its treatment. (Expert Opinion)
40. 进行前列腺癌根治性切除的所有局灶性前列腺癌患者，均可行盆腔淋巴结清扫。对于预后欠佳的中危组或高危局灶性前列腺癌患者，建议进行盆腔淋巴结清扫。应告知患者的常见并发症如淋巴囊肿及相应处理措施。（专家意见）
41. Clinicians should inform localized prostate cancer patients with unfavorable intermediate-risk or high-risk prostate cancer about benefits and risks related to the potential option of adjuvant radiotherapy when locally extensive prostate cancer is found at prostatectomy. (Moderate Recommendation; Evidence Level: Grade B)
41. 对于预后不佳的中危、高危局灶性前列腺癌患者来说，临床医师应告知其在前列腺癌切除术中如发现肿瘤局部进展时联合实施辅助放疗所带来的获益及风险。（中度推荐；证据水平：B级）
Radiotherapy
放射治疗
42. Clinicians may offer single modality external beam radiotherapy or brachytherapy for patients who elect radiotherapy for low-risk localized prostate cancer. (Clinical Principle)
42. 临床医生可以为选择放射治疗低危局限性前列腺癌的患者提供单模态外照射放疗或近距离放射治疗。（临床原则）
43. Clinicians may offer external beam radiotherapy or brachytherapy alone or in combination for favorable intermediate-risk localized prostate cancer. (Clinical Principle)
43. 临床医生可以提供单独或联合外放射治疗或近距离放射治疗，以治疗中危局灶性前列腺癌。（临床原则）
44. Clinicians should offer 24-36 months of ADT as an adjunct to either external beam radiotherapy alone or external beam radiotherapy combined with brachytherapy to patients electing radiotherapy for high-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)
44. 临床医生应为选择放射治疗高危局灶性前列腺癌的患者提供24-36个月的ADT，作为单独外放疗或外放疗联合近距离放射治疗的辅助手段。（强烈推荐；证据水平：A级）
45. Clinicians should inform localized prostate cancer patients that use of ADT with radiation increases the likelihood and severity of adverse treatment-related events on sexual function in most men and can cause other systemic side effects. (Strong Recommendation; Evidence Level: Grade B)
45. 临床医生应告知局灶性前列腺癌患者，使用放射治疗联合ADT治疗会增加大多数男性性功能不良治疗相关事件的可能性和严重程度，并可能引起其他全身性副作用。（强烈推荐；证据水平：B级）
46. Clinicians should consider moderate hypofractionation when the localized prostate cancer patient (of any risk category) and clinician decide on external beam radiotherapy to the prostate (without nodal radiotherapy). (Moderate Recommendation; Evidence Level: Grade B)
46. 如局灶性前列腺癌患者（任何风险分组）及临床医师考虑对前列腺（不包括淋巴结）进行外放射治疗时，应考虑适度分割方案。（中度推荐；证据水平：B级）
47. For localized prostate cancer patients with obstructive, non-cancer-related lower urinary function, surgical approaches may be preferred. If radiotherapy is used for these patients or those with previous significant transurethral resection of the prostate, low-dose rate brachytherapy should be discouraged. (Moderate Recommendation; Evidence Level: Grade C)
47. 对于合并梗阻尿路梗阻、非肿瘤相关下尿道功能障碍的局灶性前列腺癌患者，首选手术治疗。这类患者以及此前进行过经尿道前列腺切除的患者如进行放疗，不推荐进行低剂量率的近距离放疗。（中度推荐议；证据水平：C级）
48. Clinicians should inform localized prostate cancer patients who are considering proton beam therapy that it offers no clinical advantage over other forms of definitive treatment. (Moderate Recommendation; Evidence Level: Grade C)
48. 临床医生应该告知正在考虑质子束治疗的局部前列腺癌患者，与其他形式的确定性治疗相比，它没有临床优势。（中等推荐；证据水平：C级）
49. Clinicians should inform localized prostate cancer patients considering brachytherapy that it has similar effects as external beam radiotherapy with regard to erectile dysfunction and proctitis but can also exacerbate urinary obstructive symptoms. (Expert Opinion)
49. 如局灶性前列腺癌患者考虑进行近距离放疗，临床医师应告知这一方案对勃起功能及直肠炎的影响与外放射近似，且也可加剧尿路梗阻症状。（专家意见）
Whole Gland Cryosurgery
全腺体冷冻治疗
50. Clinicians may consider whole gland cryosurgery in low- and intermediate-risk localized prostate cancer patients who are not suitable for either radical prostatectomy or radiotherapy due to comorbidities yet have >10 year life expectancy. (Expert Opinion)
50. 由于合并症而不适合根治性前列腺切除术或放射治疗但具有>10年的预期寿命的低、中危局灶性前列腺癌患者，临床医生可考虑行全腺体冷冻手术。（专家意见）
51. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that cryosurgery has similar progression-free survival as did non-dose escalated external beam radiation (also given with neoadjuvant hormonal therapy) in low- and intermediate-risk disease, but conclusive comparison of cancer mortality is lacking. (Conditional Recommendation; Evidence Level: Grade C)
51. 临床医生应该告知考虑行全腺体冷冻治疗的局部前列腺癌患者，冷冻手术具有与低剂量、中危患者非剂量递增的外放射治疗（也用新辅助内分泌治疗）相似的无进展生存期，但是缺乏对癌症死亡率的结论性比较。（一定前提条件下推荐；证据水平：C级）
52. Defects from prior transurethral resection of the prostate are a relative contraindication for whole gland cryosurgery due to the increased risk of urethral sloughing. (Clinical Principle)
52. 此前经尿道前列腺切除所致的腺体缺损是全腺体冷冻治疗的相对禁忌症，因为会增加尿道闭锁的风险（临床原则）。
53. For whole gland cryosurgery treatment, clinicians should utilize a third or higher generation, argon-based cryosurgical system for whole gland cryosurgery treatment. (Clinical Principle)
53. 对于全腺体冷冻手术治疗，临床医生应该使用第三代或更高代的氩气冷冻外科系统进行全腺体冷冻手术治疗。（临床原理）
54. Clinicians should inform localized prostate cancer patients considering cryosurgery that it is unclear whether or not concurrent ADT improves cancer control, though it can reduce prostate size to facilitate treatment. (Clinical Principle)
54. 对于考虑进行冷冻治疗的局灶性前列腺癌患者来说，临床医师应告知目前尚不清楚同时进行ADT治疗是否可以改善癌症控制，但可使前列腺体积减小而利于治疗。（临床原则）
55. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that erectile dysfunction is an expected outcome. (Clinical Principle)
55. 对于考虑进行全腺体冷冻治疗的患者来说，临床医师应告知很可能出现勃起功能障碍。（临床原则）
56. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery about the adverse events of urinary incontinence, irritative and obstructive urinary problems. (Strong Recommendation; Evidence Level: Grade B)
56. 对于考虑进行冷冻治疗的局灶性前列腺癌患者来说，临床医师应告知会有尿失禁、尿路刺激、尿路梗阻等不良事件。（强烈建议；证据水平：B级）
HIFU and Focal Therapy
高能聚焦超声（high intensity focused ultrasound）和局部治疗
57. Clinicians should inform those localized prostate cancer patients considering focal therapy or HIFU that these treatment options lack robust evidence of efficacy. (Expert Opinion)
57. 临床医生应告知那些考虑局灶性治疗或HI-FU的局灶性前列腺癌患者，这些治疗方案缺乏有效的证据。（专家意见）
58. Clinicians should inform localized prostate cancer patients who are considering HIFU that even though HIFU is approved by the FDA for the destruction of prostate tissue, it is not approved explicitly for the treatment of prostate cancer (Expert Opinion).
58. 临床医生应告知正在考虑HIFU的局部前列腺癌患者即使HIFU被FDA批准用于前列腺组织的破坏，也不能明确批准用于治疗前列腺癌。（专家意见）
59. Clinicians should advise localized prostate cancer patients considering HIFU that tumor location may influence oncologic outcome. Limiting apical treatment to minimize morbidity increases the risk of cancer persistence. (Moderate Recommendation; Evidence Level: Grade C)
59. 临床医生应建议考虑HIFU的局限性前列腺癌患者肿瘤位置可能影响肿瘤学结果。仅对病灶部位进行治疗时并发症风险最低，但会增加癌残留的风险。（中等推荐；证据水平：C级）
60. As prostate cancer is often multifocal, clinicians should inform localized prostate cancer patients considering focal therapy that focal therapy may not be curative and that further treatment for prostate cancer may be necessary. (Expert Opinion)
60. 由于前列腺癌通常是多灶性的，临床医生应该告知局部前列腺癌患者，仅行局部治疗可能无法达到治愈目的，可能还需进一步针对前列腺癌进行治疗。（专家意见）
OUTCOME EXPECTATIONS AND MANAGEMENT
Treatment Side Effects and Health Related Quality of Life
结果期望和管理
治疗副作用和健康相关的生活质量
61. Clinicians should inform localized prostate cancer patients that erectile dysfunction occurs in many patients following prostatectomy or radiation, and that ejaculate will be lacking despite preserved ability to attain orgasm, whereas observation does not cause such sexual dysfunction. (Strong Recommendation; Evidence Level: Grade B)
61. 临床医生应告知局部前列腺癌患者，在前列腺切除术或放射治疗后许多患者中发生勃起功能障碍，尽管保留了获得性高潮的能力，但射精仍会不足，而观察并不会引起这种性功能障碍。（强烈推荐；证据水平：B级）
62. Clinicians should inform localized prostate cancer patients that long-term obstructive or irritative urinary problems occur in a subset of patients following observation or active surveillance or following radiation, whereas prostatectomy can relieve pre-existing urinary obstruction. (Strong Recommendation; Evidence Level: Grade B)
62. 临床医生应告知局部前列腺癌患者，在观察或主动监测或随后的放射治疗后，一部分患者会出现长期梗阻性或刺激性尿路问题，而前列腺切除术可缓解已存在的尿路梗阻。（强烈推荐；证据水平：B级）
63. Clinicians should inform localized prostate cancer patients that whole-gland cryosurgery is associated with worse sexual side effects and similar urinary and bowel/rectal side effects as those after radiotherapy. (Strong Recommendation; Evidence Level: Grade B)
63. 临床医生应告知局部前列腺癌患者，全腺冷冻手术与放疗后的勃起功能副作用和类似的尿和肠管/直肠副作用相关。（强烈推荐；证据水平：B级）
64. Clinicians should inform localized prostate cancer patients that temporary urinary incontinence occurs in most patients after prostatectomy and persists long-term in a small but significant subset, more than duringobservation or active surveillance or after radiation. (Strong Recommendation; Evidence Level: Grade A)
64. 临床医师应告知局灶性前列腺癌患者：前列腺切除术后大部分患者会出现暂时的尿失禁，小部分患者会出现持续性尿失禁，但这一比例远多于观察组、随访组、放疗组。（强烈建议；证据水平：A级）
65. Clinicians should inform localized prostate cancer patients that temporary proctitis following radiation persists in some patients long-term in a small but significant subset and is rare during observation or active surveillance or after prostatectomy. (Strong Recommendation; Evidence Level: Grade A)
65. 临床医师应告知局灶性前列腺癌患者：部分患者放射治疗后会出现短暂性直肠炎，小部分患者会持续很长时间，而观察、随访、前列腺切除后则少见。（强烈建议，A级证据）
Post-Treatment Follow Up
后续治疗随访
66. Clinicians should monitor localized prostate cancer patients post therapy with PSA, even though not all PSA recurrences are associated with metastatic disease and prostate cancer specific death. (Clinical Principle)
66. 尽管并非所有的PSA复发均与前列腺癌转移性、前列腺癌特异性死亡有关，但临床医师应注意监测局灶性前列腺癌患者治疗后的PSA。（临床原则）
67. Clinicians should inform localized prostate cancer patients of their individualized risk-based estimates of posttreatment prostate cancer recurrence. (Clinical Principle)
67. 临床医师应告知局灶性前列腺癌患者治疗后复发的个体化风险评估结果。（临床原则）
68. Clinicians should support localized prostate cancer patients who have survivorship or outcomes concerns by facilitating symptom management and encouraging engagement with professional or community-based resources. (Clinical Principle)
68. 对生存或预后较关注的局灶性前列腺癌患者，临床医师应通过治疗来减轻其症状，鼓励其通过专业、或社区的资源来获得支持。（临床原则）
*翻译仅供学习交流，不作为临床实践标准
编译：罗晓辉(陕西省宝鸡市中心医院)
编辑：榭小仙
审核：张建球 张弛