Danielson Brita, Saad Fred, So Alan, Morgan Scott, Hamilton Robert J, Malone Shawn, Park-Wyllie Laura, Zardan Anousheh, Shayegan Bobby
Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.
Can Urol Assoc J. 2019 Dec;13(12):420-426. doi: 10.5489/cuaj.5600. Epub 2019 Feb 7.
Current prostate cancer (PCa) guidelines primarily focus on localized or metastatic PCa. A multidisciplinary genitourinary oncology panel determined that additional guidance focusing on monitoring and management of biochemical recurrence (BCR) following radical therapy and non-metastatic castration-resistant prostate cancer (nmCRPC) was warranted.
The most up-to-date national and international guidelines, consensus statements, and emerging phase 3 trials were identified and used to inform development of algorithms by a multidisciplinary genitourinary oncology panel outlining optimal monitoring and treatment for patients with non-metastatic PCa.
A total of eight major national and international guidelines/consensus statements published since 2015 and three phase 3 trials were identified. Working group discussions among the multidisciplinary genitourinary oncology panel led to the development of two algorithms: the first addressing management of patients with BCR following radical therapy (post-BCR), and the second addressing management of nmCRPC. The post-BCR algorithm suggests consideration of early salvage treatment in select patients and provides guidance regarding observation vs. intermittent or continuous androgen-deprivation therapy (ADT). The nmCRPC algorithm suggests continued ADT and monitoring for all patients, with consideration of treatment with apalutamide or enzalutamide for patients with high-risk disease (prostate-specific antigen [PSA] doubling time of ≤ 10 months).
Two treatment algorithms have been developed to guide the management of non-metastatic PCa and should be considered in the context of local guidelines and practice patterns.
当前前列腺癌（PCa）指南主要聚焦于局限性或转移性PCa。一个多学科泌尿生殖肿瘤学小组认为，有必要制定额外的指南，重点关注根治性治疗后生化复发（BCR）的监测和管理以及非转移性去势抵抗性前列腺癌（nmCRPC）。
确定了最新的国家和国际指南、共识声明以及正在进行的3期试验，并用于为一个多学科泌尿生殖肿瘤学小组制定算法提供参考，该算法概述了非转移性PCa患者的最佳监测和治疗方法。
共确定了自2015年以来发布的八项主要国家和国际指南/共识声明以及三项3期试验。多学科泌尿生殖肿瘤学小组的工作组讨论促成了两种算法的制定：第一种算法涉及根治性治疗后BCR患者（BCR后）的管理，第二种算法涉及nmCRPC的管理。BCR后算法建议在特定患者中考虑早期挽救治疗，并提供关于观察与间歇性或持续性雄激素剥夺治疗（ADT）的指导。nmCRPC算法建议对所有患者持续进行ADT并进行监测，对于高危疾病（前列腺特异性抗原[PSA]倍增时间≤10个月）患者，考虑使用阿帕他胺或恩杂鲁胺进行治疗。
已制定了两种治疗算法来指导非转移性PCa的管理，应结合当地指南和实践模式予以考虑。
