Alcaraz A, Medina R, Maroto P, Climent M Á, Castellano D, Carles J
Servicio de Urología, IDIBAPS, Hospital Clínic de Barcelona, Barcelona, España.
Actas Urol Esp. 2012 Jun;36(6):367-74. doi: 10.1016/j.acuro.2011.10.010. Epub 2011 Dec 19.
Hormonal therapy allows effective control of cancer-related symptoms in advanced stages. However, the disease will progress in almost all these metastatic prostate cancer patient until becoming resistant to androgen suppression. The emergence of new drugs will most probably have open up new expectations regarding the treatment of this cancer.
The aim of the present review has been to provide an overview of the current status of castration-resistant prostate cancer and to share the high expectations created with the new treatments.
Evidence was obtained from multidisciplinary meetings with the participation of urologists and oncologists, where they pooled the analysis of original articles in the literature and defined the content of the article.
Chemotherapy with docetaxel was a turning point in castration-resistant prostate cancer after the failure of hormonal therapy failure. For the first time, it achieved increased survival time in comparison with mitoxantrone and prednisone. Combination therapy with docetaxel and prednisone is the first-line choice treatment. Once the cancer has progressed, there is no clear alternative, although some novel agents have created expectations for the treatment of this type of cancer.
The range of therapeutic options for castration-resistant prostate cancer has increased dramatically with the arrival of new drugs. At present, cabazitaxel, and in the near future, abiraterone, have been found to be effective drugs in second-line treatment after progression to docetaxel, increasing survival by 2-4 months and reducing risk of death by 30-35%.
激素疗法能够有效控制晚期癌症相关症状。然而，几乎所有这些转移性前列腺癌患者的疾病都会进展，直至对雄激素抑制产生耐药性。新药的出现很可能为这种癌症的治疗带来新的期望。
本综述的目的是概述去势抵抗性前列腺癌的现状，并分享新治疗方法带来的高期望。
证据来自泌尿科医生和肿瘤学家参与的多学科会议，他们汇总了文献中原始文章的分析并确定了文章内容。
在激素治疗失败后，多西他赛化疗是去势抵抗性前列腺癌的一个转折点。与米托蒽醌和泼尼松相比，它首次实现了生存时间的延长。多西他赛与泼尼松联合治疗是一线选择治疗方法。一旦癌症进展，虽然一些新型药物为这类癌症的治疗带来了期望，但尚无明确的替代方案。
随着新药的出现，去势抵抗性前列腺癌的治疗选择范围大幅增加。目前，卡巴他赛以及在不久的将来阿比特龙，已被发现是多西他赛进展后二线治疗的有效药物，可使生存期延长2 - 4个月，并将死亡风险降低30 - 35%。
