Center of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute.
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Curr Opin Urol. 2020 Jul;30(4):576-583. doi: 10.1097/MOU.0000000000000778.
Systemic treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have recently shifted from the traditional androgen deprivation therapy (ADT) monotherapy to multidrug approaches incorporating drugs initially approved for castration-resistant state and ADT. However, clinicians have difficulties in choosing the adequate combination therapy for individualized patient care, because of the lack of consensus regarding disease risk factors, differences in study design of the major clinical trials and lack of direct comparisons between drugs. The aim of this review is to provide an update of the current treatment options for this heterogenous group of patients.
Current oncological guidelines strongly recommend that patients with newly diagnosed mHSPC and high-volume disease (CHAARTED criteria) should receive docetaxel and ADT, whereas those with high-risk disease (LATITUDE criteria) abiraterone and ADT. Recently, the Food and Drug Administration approved apalutamide and enzalutamide for mHSPC. Moreover, new data support the efficacy of docetaxel and abiraterone in patients with mHSPC, regardless of metastatic burden.
Today, the combination approach should be recommended for newly diagnosed mHSPC over ADT monotherapy, but treatment initiation must be personalized based on disease, drug and patient characteristics. Thanks to continuous efforts and progress in patient and disease-related outcomes, mHSPC could become a chronic disease.
转移性激素敏感前列腺癌（mHSPC）的系统治疗选择最近已从传统的雄激素剥夺疗法（ADT）单药治疗转变为包含最初批准用于去势抵抗状态和 ADT 的药物的多药物方法。然而，由于缺乏关于疾病风险因素的共识、主要临床试验设计的差异以及药物之间缺乏直接比较，临床医生在为个体化患者治疗选择合适的联合治疗方案方面存在困难。本文的目的是为这组异质性患者提供当前治疗选择的最新信息。
目前的肿瘤学指南强烈建议新诊断为 mHSPC 且有大量疾病（CHAARTED 标准）的患者应接受多西他赛和 ADT，而有高危疾病（LATITUDE 标准）的患者应接受阿比特龙和 ADT。最近，美国食品和药物管理局批准阿帕鲁胺和恩扎鲁胺用于 mHSPC。此外，新数据支持多西他赛和阿比特龙在 mHSPC 患者中的疗效，无论转移负担如何。
如今，联合治疗方案应推荐用于新诊断的 mHSPC，优于 ADT 单药治疗，但必须根据疾病、药物和患者特征进行个体化治疗。由于在患者和疾病相关结局方面的持续努力和进展，mHSPC 可能成为一种慢性疾病。
