Cha Eugene K, Eastham James A
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Urol Oncol. 2015 May;33(5):217-25. doi: 10.1016/j.urolonc.2014.11.020. Epub 2015 Jan 14.
Although both surgery and radiation are potential curative options for men with clinically localized prostate cancer, a significant proportion of men with high-risk and locally advanced disease will demonstrate biochemical and potentially clinical progression of their disease. Neoadjuvant systemic therapy before radical prostatectomy (RP) is a logical strategy to improve treatment outcomes for men with clinically localized high-risk prostate cancer. Furthermore, delivery of chemotherapy and other systemic agents before RP affords an opportunity to explore the efficacy of these agents with pathologic end points. Neoadjuvant chemotherapy, primarily with docetaxel (with or without androgen deprivation therapy), has demonstrated feasibility and safety in men undergoing RP, but no study to date has established the efficacy of neoadjuvant chemotherapy or neoadjuvant chemohormonal therapies. Other novel agents, such as those targeting the vascular endothelial growth factor receptor, epidermal growth factor receptor, platelet-derived growth factor receptor, clusterin, and immunomodulatory therapeutics, are currently under investigation.
虽然手术和放疗都是临床局限性前列腺癌男性患者潜在的治愈性选择，但相当一部分高危和局部晚期疾病的男性患者会出现疾病的生化进展，甚至可能出现临床进展。根治性前列腺切除术（RP）前的新辅助全身治疗是改善临床局限性高危前列腺癌男性患者治疗效果的合理策略。此外，在RP前给予化疗和其他全身药物提供了一个以病理终点探索这些药物疗效的机会。新辅助化疗，主要是多西他赛（联合或不联合雄激素剥夺治疗），已在接受RP的男性患者中证明了可行性和安全性，但迄今为止尚无研究确定新辅助化疗或新辅助化疗激素疗法的疗效。其他新型药物，如靶向血管内皮生长因子受体、表皮生长因子受体、血小板衍生生长因子受体、簇集素的药物以及免疫调节疗法，目前正在研究中。
