Kleinclauss F, Thiery-Vuillemin A
Service d'urologie, andrologie et transplantation rénale, CHRU Besançon, Besançon, France; Université de Franche-Comté, Besançon, France; INSERM 1098, Besançon, France.
Université de Franche-Comté, Besançon, France; INSERM 1098, Besançon, France; Service d'oncologie médicale, CHRU Besançon, Besançon, France.
Prog Urol. 2019 Jun;29 Suppl 1:S20-S34. doi: 10.1016/S1166-7087(19)30167-8.
To review biology and management of oligometastatic prostate cancer.
Relevant publications were identified through Medline (www. ncbi.nlm.nih.gov), Embase (www.embase.com) and the US National Library of Medicine (www.clinicaltrials.org) databases using the following keywords, alone or in association, «prostate cancer; metastasis; oligo-metastasis». Articles were selected according to methods, language of publication and relevance. After careful selection 99 publications were eligible for our review.
Oligometastatic prostate cancer is a new entity including prostate cancer with a limited number of metastasis. This particular state becomes more frequent with the imaging progresses especially with the common use of new PET imaging with Choline or PSMA. There is no consensus about a strict definition of oligometastatic prostate cancer, number and sites of metastasis vary widely in the literature. Moreover, oligometastatic state can be observed de novo at the time of prostate cancer diagnosis as well as in case of recurrence after a primary treatment. There is actually an important lack of evidence-based medicine and no guidelines regarding treatment can be found. In de novo oligo-metatastatic prostate cancer, treatment of the primary tumor in association with androgen deprivation therapy seems to increase survival in selected patients but this needs to be confirmed by ongoing prospective clinical trials. In recurrent prostate cancer, metastasis directed therapy with or without androgen deprivation therapy is now routinely performed but its impact needs also to be analyzed.
In absence of consensus or guidelines, management of prostate cancer should be an individualized, patient-based management taking into account primary tumor stage and grade, number and types of metastasis and patient characteristics.
综述寡转移前列腺癌的生物学特性及治疗方法。
寡转移前列腺癌是一种新的实体，指转移灶数量有限的前列腺癌。随着影像学技术的进步，尤其是胆碱或前列腺特异性膜抗原新型PET成像的广泛应用，这种特殊状态越来越常见。关于寡转移前列腺癌的严格定义尚无共识，文献中转移灶的数量和部位差异很大。此外，寡转移状态可在前列腺癌诊断时初发出现，也可在初次治疗后的复发情况下出现。目前实际上严重缺乏循证医学依据，也未找到关于治疗的指南。在初发寡转移前列腺癌中，原发肿瘤治疗联合雄激素剥夺治疗似乎能提高部分患者的生存率，但这需要正在进行的前瞻性临床试验予以证实。在复发性前列腺癌中，目前常规进行有或无雄激素剥夺治疗的转移灶定向治疗，但其效果也需要分析。
在缺乏共识或指南的情况下，前列腺癌的治疗应是个体化的、基于患者的治疗，需考虑原发肿瘤的分期和分级、转移灶的数量和类型以及患者特征。
