Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany.
Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
Cancer Treat Rev. 2019 May;75:20-26. doi: 10.1016/j.ctrv.2019.03.001. Epub 2019 Mar 11.
Recently, adoption of novel drugs for systemic treatment of metastatic prostate cancer has led to a striking improvement of response rate and survival in both hormone-sensitive and castration-resistant disease. In most cases, prostate cancer essentially depends on androgen receptor signaling axis, even in castration-resistant setting, and hence may be targeted by second generation hormonal therapy. However, a subset of patients bears androgen-independent cancer biology with a short-term response to hormonal treatment, early and extensive visceral metastases, low PSA levels and poor outcomes. Identification and specific management of these rapidly fatal malignancies is of an unmet medical need since their classification and utilized therapeutic regimens vary significantly. Unfortunately, molecular pathways have not been sufficiently elucidated yet in order to provide an effective targeted treatment with a prolonged response. Lack of diagnostic and predictive biomarkers for these cancers makes successful counteractions against them even more sophisticated. In this comprehensive review, we aimed at summarizing the current body of literature reporting on causal molecular machinery as well as diagnostic and therapeutic concepts of aggressive prostate tumors and draw clinically relevant conclusions for the up-to-date sensible disease management.
最近，新型药物被采用用于转移性前列腺癌的系统治疗，这使得激素敏感和去势抵抗疾病的反应率和生存率都有了显著提高。在大多数情况下，前列腺癌本质上依赖于雄激素受体信号轴，即使在去势抵抗的情况下也是如此，因此可以用第二代激素治疗来靶向治疗。然而，有一部分患者的肿瘤具有雄激素非依赖性生物学特性，对激素治疗的反应短暂，早期且广泛的内脏转移，PSA 水平低，预后不良。这些快速致命性恶性肿瘤的鉴定和特定管理是未满足的医疗需求，因为它们的分类和所采用的治疗方案有很大的不同。不幸的是，目前还没有充分阐明分子途径，以便提供有效的靶向治疗和延长反应时间。这些癌症缺乏诊断和预测生物标志物，使得对它们的成功对抗更加复杂。在这篇全面的综述中，我们旨在总结目前关于侵袭性前列腺肿瘤的因果分子机制以及诊断和治疗概念的文献，并为最新的合理疾病管理得出临床相关结论。
