Rozet Francois, Roumeguère Thierry, Spahn Martin, Beyersdorff Dirk, Hammerer Peter
Department of Urology, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
Department of Urology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
World J Urol. 2016 Nov;34(11):1505-1513. doi: 10.1007/s00345-016-1803-9. Epub 2016 Mar 17.
Guidelines on the clinical management of non-metastatic castrate-resistant prostate cancer (nmCRPC) generally focus on the need to continue androgen deprivation therapy and enrol patients into clinical trials of investigational agents. This guidance reflects the lack of clinical trial data with established agents in the nmCRPC patient population and the need for trials of new agents.
To review the evidence base and consider ways of improving the management of nmCRPC.
Upon the development of castrate resistance, it is essential to rule out the presence of metastases or micrometastases by optimising the use of bone scans and possibly newer procedures and techniques. When nmCRPC is established, management decisions should be individualised according to risk, but risk stratification in this diverse population is poorly defined. Currently, prostate-specific antigen (PSA) levels and PSA doubling time remain the best method of assessing the risk of progression and response to treatment in nmCRPC. However, optimising imaging protocols can also help assess the changing metastatic burden in patients with CRPC. Clinical trials of novel agents in nmCRPC are limited and have problems with enrolment, and therefore, improved risk stratification and imaging may be crucial to the improved management. The statements presented in this paper, reflecting the views of the authors, provide a discussion of the most recent evidence in nmCRPC and provide some advice on how to ensure these patients receive the best management available. However, there is an urgent need for more data on the management of nmCRPC.
非转移性去势抵抗性前列腺癌（nmCRPC）的临床管理指南通常侧重于继续雄激素剥夺治疗的必要性以及让患者参与研究药物的临床试验。该指南反映了在nmCRPC患者群体中缺乏已确立药物的临床试验数据以及对新药试验的需求。
回顾证据基础并考虑改善nmCRPC管理的方法。
在出现去势抵抗后，通过优化骨扫描以及可能的更新程序和技术来排除转移灶或微转移灶的存在至关重要。当nmCRPC确诊后，管理决策应根据风险进行个体化，但在这个多样化的群体中，风险分层定义不明确。目前，前列腺特异性抗原（PSA）水平和PSA倍增时间仍然是评估nmCRPC进展风险和治疗反应的最佳方法。然而，优化成像方案也有助于评估CRPC患者不断变化的转移负担。nmCRPC新型药物的临床试验有限且存在入组问题，因此，改善风险分层和成像对于改善管理可能至关重要。本文中的陈述反映了作者的观点，对nmCRPC的最新证据进行了讨论，并就如何确保这些患者获得最佳管理提供了一些建议。然而，迫切需要更多关于nmCRPC管理的数据。
