University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, California 90033, USA.
Curr Opin Urol. 2013 Jul;23(4):366-71. doi: 10.1097/MOU.0b013e328361d467.
Although most men are diagnosed with readily curable localized prostate cancer, those with high-risk features face a significant mortality risk. Androgen deprivation therapy (ADT) is a standard adjunct to radiotherapy for high-risk prostate cancer, but its role around prostatectomy has not been as clearly defined, and concerns over cardiovascular toxicity have led to decreasing use. The use of chemotherapy for localized disease remains experimental. We review the most recently published trials of neoadjuvant or adjuvant systemic therapy for prostate cancer.
The optimal duration of ADT with higher dose modern radiation techniques is under active investigation, but current data support the use of longer duration as standard. Prostate-specific antigen (PSA) and MRI changes may be useful in future studies optimizing duration of neoadjuvant ADT. Two years of combined ADT after prostatectomy is associated with a lower risk of disease recurrence and better prostate cancer specific mortality than predicted. Persistence of intraprostatic androgens during neoadjuvant ADT may contribute to resistance.
Androgen deprivation added to definitive radiation or surgery improves outcomes for high-risk prostate cancer, although the role of chemotherapy remains undefined. Molecular classification is needed to improve risk stratification.
尽管大多数男性被诊断为可治愈的局限性前列腺癌，但那些具有高危特征的患者面临着显著的死亡风险。雄激素剥夺疗法（ADT）是高危前列腺癌放射治疗的标准辅助手段，但 ADT 在前列腺切除术周围的作用尚未明确界定，而且对心血管毒性的担忧导致其使用减少。化疗在局限性疾病中的应用仍处于试验阶段。我们回顾了最近发表的关于前列腺癌新辅助或辅助全身治疗的试验。
高剂量现代放射技术下 ADT 的最佳持续时间正在积极研究中，但目前的数据支持将更长的持续时间作为标准。前列腺特异性抗原（PSA）和 MRI 变化可能在未来研究中有助于优化新辅助 ADT 的持续时间。前列腺切除术联合 ADT 2 年与疾病复发风险降低和前列腺癌特异性死亡率降低相关，优于预测。在新辅助 ADT 期间，前列腺内雄激素的持续存在可能导致耐药性。
雄激素剥夺治疗联合确定性放疗或手术可改善高危前列腺癌的预后，尽管化疗的作用仍未确定。需要进行分子分类以改善风险分层。
