Barsouk Adam, Padala Sandeep Anand, Vakiti Anusha, Mohammed Azeem, Saginala Kalyan, Thandra Krishna Chaitanya, Rawla Prashanth, Barsouk Alexander
Department of Hematology-Oncology, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA.
Department of Medicine, Nephrology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Med Sci (Basel). 2020 Jul 20;8(3):28. doi: 10.3390/medsci8030028.
Prostate cancer is the second most common and fifth most aggressive neoplasm among men worldwide. It is particularly incident in high human development index (HDI) nations, with an estimated one in seven men in the US receiving a prostate cancer diagnosis in their lifetime. A rapid rise and then fall in prostate cancer incidence in the US and Europe corresponded to the implementation of widespread prostate specific antigen (PSA) testing in 1986 and then subsequent fall from favor due to high rates of false positives, overdiagnosis, and overtreatment (as many as 20-50% of men diagnosed could have remained asymptomatic in their lifetimes). Though few risk factors have been characterized, the best known include race (men of African descent are at higher risk), genetics (e.g., BRCA1/2 mutations), and obesity. The Gleason scoring system is used for histopathological staging and is combined with clinical staging for prognosis and treatment. National guidelines have grown more conservative over the past decades in management, recommending watchful waiting and observation in older men with low to intermediate risk disease. Among higher risk patients, prostatectomy (robotic is preferred) and/or external beam radiotherapy is the most common interventions, followed by ADT maintenance. Following progression on androgen deprivation therapy (ADT) (known as castration-resistance), next generation endocrine therapies like enzalutamide, often in combination with cytotoxic agent docetaxel, are standard of care. Other promising treatments include Radium-223 for bone metastases, pembrolizumab for programmed death ligand-1 (PDL1) and microsatellite instability (MSI) high disease, and poly ADP ribose polymerase (PARP) inhibitors for those with mutations in homologous recombination (most commonly BRCA2).
前列腺癌是全球男性中第二常见且第五具侵袭性的肿瘤。在人类发展指数（HDI）较高的国家尤为高发，据估计，美国每七名男性中就有一人在一生中会被诊断出患有前列腺癌。美国和欧洲前列腺癌发病率先迅速上升后下降，这与1986年广泛开展前列腺特异性抗原（PSA）检测相对应，随后由于假阳性率高、过度诊断和过度治疗（多达20%-50%被诊断出的男性在一生中可能一直无症状），该检测不再受青睐。尽管已明确的风险因素较少，但最广为人知的包括种族（非洲裔男性风险更高）、遗传学（如BRCA1/2突变）和肥胖。 Gleason评分系统用于组织病理学分期，并与临床分期相结合以进行预后和治疗。在过去几十年中，国家管理指南变得更加保守，建议对低至中度风险疾病的老年男性进行密切观察。在高风险患者中，前列腺切除术（首选机器人手术）和/或外照射放疗是最常见的干预措施，其次是雄激素剥夺治疗（ADT）维持治疗。在雄激素剥夺治疗（ADT）进展后（即去势抵抗），新一代内分泌治疗药物如恩杂鲁胺，通常与细胞毒性药物多西他赛联合使用，是标准治疗方案。其他有前景的治疗方法包括用于骨转移的镭-223、用于程序性死亡配体-１（PDL1）和微卫星不稳定性（MSI）高的疾病的帕博利珠单抗，以及用于同源重组突变（最常见的是BRCA2）患者的聚ADP核糖聚合酶（PARP）抑制剂。
