Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Clin Adv Hematol Oncol. 2021 Jul;19(7):460-467.
Oligometastatic prostate cancer is a subtype of metastatic disease that generally is defined by the presence of 5 or fewer metastatic lesions. Metastatic prostate cancer currently is treated with androgen deprivation therapy and additional systemic therapy, such as novel antiandrogen medications or chemotherapy. The management of metastatic prostate cancer is evolving, however, with the notion that some patients with low-burden metastatic disease may benefit from both local and systemic therapy. Local therapy of the prostate in the setting of oligometastatic prostate cancer is a new concept. Evidence from retrospective studies suggests that cytoreductive therapy, including radical prostatectomy, can improve overall survival in these patients. Ongoing randomized trials are comparing cytoreductive therapy with standard-of-care treatment options. Local therapy in the form of radiation has also been investigated in phase 2 randomized trials. In this review, we discuss the biological and clinical rationales for local therapy, review the current evidence for local therapy, and compare the clinical designs of various ongoing trials.
寡转移前列腺癌是一种转移性疾病的亚型，通常定义为存在 5 个或更少的转移病灶。转移性前列腺癌目前采用雄激素剥夺疗法和其他全身治疗，如新型抗雄激素药物或化疗。然而，转移性前列腺癌的治疗正在不断发展，因为一些低负担转移性疾病患者可能受益于局部和全身治疗。寡转移前列腺癌中前列腺的局部治疗是一个新概念。来自回顾性研究的证据表明，包括根治性前列腺切除术在内的细胞减少治疗可以改善这些患者的总生存。正在进行的随机试验正在比较细胞减少治疗与标准治疗选择。放疗形式的局部治疗也在 2 期随机试验中进行了研究。在这篇综述中，我们讨论了局部治疗的生物学和临床依据，回顾了局部治疗的现有证据，并比较了各种正在进行的试验的临床设计。
