Hegemann Miriam, Maas Moritz, Rausch Steffen, Walz Simon, Bedke Jens, Stenzl Arnulf, Todenhöfer Tilman
Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany.
Asian J Androl. 2017 Dec 29;21(1):12-8. doi: 10.4103/aja.aja_59_17.
Bone metastases have a major impact on quality of life and survival of patients with advanced prostate cancer. In the last decade, the development and approval of substances inhibiting the vicious cycle of bone metastases have enabled the reduction of complications caused by bone metastases in patients with castration-resistant prostate cancer. These drugs have raised awareness of the importance of skeletal-related events which in the meantime represent an important end point also in trials using agents not specifically designed for bone lesions. Second-generation antihormonal drugs such as enzalutamide or abiraterone have been shown to have a positive impact on the incidence of skeletal complications and therefore provide an important tool in the armamentarium used for treating bone metastases. Radiopharmaceuticals such as radium-223 dichloride ([223Ra]) have been demonstrated not only to reduce skeletal-related events and bone-related pain, but also to prolong overall survival, thereby being the first bone-targeting agent showing a survival benefit. As previous studies have not provided an obvious benefit of bone-targeted lesions in castration-sensitive disease, the use of these agents is not recommended. In oligometastatic prostate cancer, the role of local treatment of metastases using stereotactic radiation or radiosurgery is a matter of intense debates and may play an increasing role in the future.
骨转移对晚期前列腺癌患者的生活质量和生存有着重大影响。在过去十年中，抑制骨转移恶性循环的药物的研发和获批，使得去势抵抗性前列腺癌患者因骨转移引起的并发症有所减少。这些药物提高了人们对骨相关事件重要性的认识，与此同时，骨相关事件在使用并非专门针对骨病变设计的药物的试验中也成为一个重要的终点。第二代抗激素药物，如恩杂鲁胺或阿比特龙，已被证明对骨骼并发症的发生率有积极影响，因此为治疗骨转移的药物库提供了一种重要工具。二氯化镭（[223Ra]）等放射性药物不仅能减少骨相关事件和骨相关疼痛，还能延长总生存期，从而成为首个显示出生存获益的骨靶向药物。由于先前的研究未在去势敏感性疾病中显示出骨靶向病变的明显益处，因此不建议使用这些药物。在寡转移性前列腺癌中，使用立体定向放射或放射外科对转移灶进行局部治疗的作用存在激烈争论，且可能在未来发挥越来越大的作用。
