Spence Winter
Alberta Health Services Cancer Control, Radiation Therapy, Cross Cancer Institute, Edmonton, Alberta, Canada.
J Med Imaging Radiat Sci. 2018 Dec;49(4):376-382. doi: 10.1016/j.jmir.2018.01.002. Epub 2018 Mar 12.
Prostate cancer continues to be the most commonly diagnosed cancer among Canadian men. The introduction of routine screening and advanced treatment options have allowed for a decrease in prostate cancer-related mortality, but outcomes following treatment continue to vary widely. In addition, the overtreatment of indolent prostate cancers causes unnecessary treatment toxicities and burdens health care systems. Accurate identification of patients who should undergo aggressive treatment, and those which should be managed more conservatively, needs to be implemented. More tumour and patient information is needed to stratify patients into low-, intermediate-, and high-risk groups to guide treatment options. This paper reviews the current literature on personalised prostate cancer management, including targeting tumour hypoxia, genomic and radiomic prognosticators, and radiobiological tumour targeting. A review of the current applications and future directions for the use of big data in radiation therapy is also presented. Prostate cancer management has a lot to gain from the implementation of personalised medicine into practice. Using specific tumour and patient characteristics to personalise prostate radiotherapy in the era of precision medicine will improve survival, decrease unnecessary toxicities, and minimise the heterogeneity of outcomes following treatment.
前列腺癌仍然是加拿大男性中最常被诊断出的癌症。常规筛查和先进治疗方案的引入使得前列腺癌相关死亡率有所下降，但治疗后的结果仍存在很大差异。此外，惰性前列腺癌的过度治疗会导致不必要的治疗毒性，并给医疗保健系统带来负担。需要准确识别哪些患者应接受积极治疗，哪些患者应采取更保守的治疗方式。需要更多的肿瘤和患者信息，以便将患者分为低风险、中风险和高风险组，从而指导治疗方案的选择。本文综述了目前关于个性化前列腺癌管理的文献，包括针对肿瘤缺氧、基因组和放射组学预后指标以及放射生物学肿瘤靶向治疗。还介绍了大数据在放射治疗中的当前应用和未来方向。将个性化医疗应用于实践，前列腺癌管理将受益匪浅。在精准医疗时代，利用特定的肿瘤和患者特征来个性化前列腺放疗，将提高生存率，减少不必要的毒性，并使治疗后结果的异质性降至最低。
