Aggarwal Rahul R, Feng Felix Y, Small Eric J
Oncology (Williston Park). 2017 Jun 15;31(6):467-74.
The treatment of advanced prostate cancer has changed significantly in the last decade, as a result of the introduction of multiple new systemic therapies that have had a positive impact on treatment outcomes. The increasing number of therapies, along with new insights into the biological underpinnings of prostate cancer, have led to a growing appreciation for the heterogeneity of the disease and an awareness of emerging subcategories that have direct therapeutic implications for the practicing clinician. In the metastatic hormone-naive setting, the extent of metastatic disease visible on scans can serve as a useful measure to guide treatment decisions; the addition of docetaxel chemotherapy to hormonal therapy has significant benefit in patients whose scans show more extensive disease. In the castration-resistant setting, abiraterone and enzalutamide have both had a transformative impact; however, the emergence of resistance to these therapies often heralds a more aggressive phenotype. Emerging clinically relevant subcategories include disease that demonstrates treatment-emergent neuroendocrine differentiation, as well as tumors with somatic and/or germline alterations in the DNA repair pathway. Identification of these subtypes has direct clinical relevance with regard to the potential benefit of platinum-based chemotherapy, poly (ADP-ribose) polymerase inhibitors, and likely further therapies as new therapeutic targets are identified in these groups.
在过去十年中，晚期前列腺癌的治疗发生了显著变化，这是由于多种新的全身治疗方法的引入，这些方法对治疗结果产生了积极影响。治疗方法的不断增加，以及对前列腺癌生物学基础的新认识，使得人们越来越认识到该疾病的异质性，并意识到出现了对临床医生有直接治疗意义的新亚类。在转移性激素初治的情况下，扫描显示的转移病灶范围可作为指导治疗决策的有用指标；对于扫描显示疾病范围更广的患者，在激素治疗中添加多西他赛化疗具有显著益处。在去势抵抗性情况下，阿比特龙和恩杂鲁胺都产生了变革性影响；然而，对这些疗法产生耐药性往往预示着更具侵袭性的表型。新出现的具有临床相关性的亚类包括表现出治疗后出现神经内分泌分化的疾病，以及在DNA修复途径中存在体细胞和/或种系改变的肿瘤。这些亚型的鉴定对于铂类化疗、聚（ADP-核糖）聚合酶抑制剂的潜在益处具有直接的临床相关性，并且随着在这些群体中确定新的治疗靶点，可能还与进一步的治疗方法相关。
