Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK; Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain.
Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK.
Eur Urol Focus. 2018 Mar;4(2):235-244. doi: 10.1016/j.euf.2016.09.005. Epub 2016 Oct 10.
Evaluation of responses to treatment for metastatic castration-resistant prostate cancer (mCRPC) remains challenging. Consensus criteria based on prostate-specific antigen (PSA) and clinical and radiologic biomarkers are inconsistently utilized. Circulating tumor cell (CTC) counts can inform prognosis and response, but are not routinely used.
To evaluate the use of biomarkers and trends in clinical decision-making in current mCRPC treatment.
DESIGN, SETTING, AND PARTICIPANTS: A 23-part online questionnaire was completed by physicians treating mCRPC.
Results are presented as the proportion (%) of physicians responding to each of the options. We used χ and Fisher's tests to compare differences.
A total of 118 physicians (22.1%) responded. Of these, 69.4% treated ≥50 mCRPC patients/year. More physicians administered four or fewer courses of cabazitaxel (27.9%) than for docetaxel (10.4%), with no significant difference in the number of courses between bone-only disease and Response Evaluation Criteria in Solid Tumours (RECIST)-evaluable disease. Some 74.5% of respondents considered current biomarkers useful for monitoring disease, but only 39.6% used the Prostate Cancer Working Group (PCWG2) criteria in clinical practice. PSA was considered an important biomarker by 55.7%, but only 41.4% discarded changes in PSA before 12 wk, and only 39.4% were able to identify bone-scan progression according to PCWG2. The vast majority of physicians (90.5%) considered clinical progression to be important for switching treatment. The proportion considering biomarkers important was 71.6% for RECIST, 47.4% for bone scans, 23.2% for CTCs, and 21.1% for PSA. Although 53.1% acknowledged that baseline CTC counts are prognostic, only 33.7% would use CTC changes alone to switch treatment in patients with bone-only disease. The main challenges in using CTC counts were access to CTC technology (84.7%), cost (74.5%), and uncertainty over utility as a response indicator (58.2%).
A significant proportion of physicians discontinue treatment for mCRPC before 12 wk, raising concerns about inadequate response assessment. Many physicians find current biomarkers useful, but most rely on symptoms to drive treatment switch decisions, suggesting there is a need for more precise biomarkers.
In this report we analyse the results of a questionnaire evaluating tools for clinical decision-making completed by 118 prostate cancer specialists. We found that most physicians favour clinical progression over prostate-specific antigen or imaging, and that criteria established by the Prostate Cancer Working Group are not widely used.
转移性去势抵抗性前列腺癌（mCRPC）治疗反应的评估仍然具有挑战性。基于前列腺特异性抗原（PSA）和临床及影像学生物标志物的共识标准并未得到一致应用。循环肿瘤细胞（CTC）计数可提供预后和反应信息，但未常规使用。
评估当前 mCRPC 治疗中生物标志物的应用及临床决策趋势。
设计、地点和参与者：对治疗 mCRPC 的医生进行了 23 部分在线问卷调查。
结果以对每种选择的医生应答比例（%）表示。我们使用 χ 2 和 Fisher 检验来比较差异。
共 118 名医生（22.1%）做出了回应。其中，69.4%的医生每年治疗≥50 例 mCRPC 患者。接受卡巴他赛治疗的患者中，有 27.9%的患者接受了 4 个或更少疗程的治疗，而接受多西他赛治疗的患者为 10.4%，骨病变和实体瘤反应评估标准（RECIST）可评估疾病之间的疗程数没有显著差异。约 74.5%的受访者认为当前的生物标志物有助于监测疾病，但只有 39.6%在临床实践中使用前列腺癌工作组（PCWG2）标准。PSA 被 55.7%的医生认为是一个重要的生物标志物，但只有 41.4%的医生在 12 周前丢弃 PSA 的变化，只有 39.4%的医生能够根据 PCWG2 识别骨扫描进展。绝大多数医生（90.5%）认为临床进展对改变治疗方案很重要。考虑到生物标志物重要性的比例为：RECIST 为 71.6%，骨扫描为 47.4%，CTC 为 23.2%，PSA 为 21.1%。尽管 53.1%的人承认基线 CTC 计数具有预后意义，但只有 33.7%的人会在仅存在骨病变的患者中单独使用 CTC 变化来改变治疗方案。使用 CTC 计数的主要挑战是无法获得 CTC 技术（84.7%）、费用（74.5%）以及对其作为反应指标的实用性的不确定性（58.2%）。
很大一部分医生在 12 周前停止了 mCRPC 的治疗，这引发了对评估反应不足的担忧。许多医生认为当前的生物标志物有用，但大多数医生依赖症状来决定治疗方案的改变，这表明需要更精确的生物标志物。
在本报告中，我们分析了对 118 名前列腺癌专家完成的评估临床决策工具的问卷的结果。我们发现，大多数医生更倾向于临床进展而不是 PSA 或影像学，且前列腺癌工作组制定的标准并未得到广泛应用。
