Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK.
Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands.
Eur Urol. 2021 Feb;79(2):263-282. doi: 10.1016/j.eururo.2020.09.046. Epub 2020 Oct 7.
OBJECTIVE: To present a summary of the 2020 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Geriatric Oncology (SIOG) guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (CRPC). EVIDENCE ACQUISITION: The working panel performed a literature review of the new data (2016-2019). The guidelines were updated, and the levels of evidence and/or grades of recommendation were added based on a systematic review of the literature. EVIDENCE SYNTHESIS: Prostate-specific membrane antigen positron emission tomography computed tomography scanning has developed an increasingly important role in men with biochemical recurrence after local therapy. Early salvage radiotherapy after radical prostatectomy appears as effective as adjuvant radiotherapy and, in a subset of patients, should be combined with androgen deprivation. New treatments have become available for men with metastatic hormone-sensitive prostate cancer (PCa), nonmetastatic CRPC, and metastatic CRPC, along with a role for local radiotherapy in men with low-volume metastatic hormone-sensitive PCa. Also included is information on quality of life outcomes in men with PCa. CONCLUSIONS: The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for use in clinical practice. These PCa guidelines are first endorsed by the EANM and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office or online (http://uroweb.org/guideline/prostate-cancer/). PATIENT SUMMARY: This article summarises the guidelines for the treatment of relapsing, metastatic, and castration-resistant prostate cancer. These guidelines are evidence based and guide the clinician in the discussion with the patient on the treatment decisions to be taken. These guidelines are updated every year; this summary spans the 2017-2020 period of new evidence.
目的：总结 2020 年版欧洲泌尿外科学会（EAU）-欧洲核医学学会（EANM）-欧洲放射肿瘤学会（ESTRO）-欧洲泌尿生殖放射学会（ESUR）-国际老年肿瘤学会（SIOG）关于复发、转移和去势抵抗性前列腺癌（CRPC）治疗的指南。
证据获取：工作组对 2016-2019 年的新数据进行了文献回顾。根据文献系统评价，更新了指南，并添加了证据水平和/或推荐等级。
证据综合：前列腺特异膜抗原正电子发射断层扫描在局部治疗后生化复发的男性中发挥了越来越重要的作用。根治性前列腺切除术后早期挽救性放疗与辅助放疗同样有效，在一部分患者中，应与雄激素剥夺联合应用。对于转移性激素敏感型前列腺癌（PCa）、非转移性 CRPC 和转移性 CRPC 患者，以及对于低容量转移性激素敏感型 PCa 患者，新的治疗方法已经可用。还包括了 PCa 患者生活质量结果的信息。
结论：晚期和转移性 PCa 和 CRPC 领域的知识正在迅速变化。2020 年 EAU-EANM-ESTRO-ESUR-SIOG 前列腺癌指南总结了最近的发现和临床实践建议。这些 PCa 指南首先得到 EANM 的认可，反映了 PCa 管理的多学科性质。完整版本可从 EAU 办公室或在线获得（http://uroweb.org/guideline/prostate-cancer/）。
患者总结：本文总结了复发、转移和去势抵抗性前列腺癌的治疗指南。这些指南是基于证据的，指导临床医生与患者讨论要采取的治疗决策。这些指南每年都会更新；本摘要涵盖了 2017-2020 年新证据的时期。
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