Ong Sean, O'Brien Jonathan, Medhurst Elizabeth, Lawrentschuk Nathan, Murphy Declan, Azad Arun
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia.
Transl Androl Urol. 2021 Oct;10(10):3918-3930. doi: 10.21037/tau-20-1118.
Prostate cancer continues to be one of the most commonly diagnosed cancers in men globally and a leading cause of male cancer deaths. The landscape of metastatic hormone-sensitive prostate cancer has significantly changed over the past decade. For many years, androgen deprivation therapy alone through surgical or chemical castration was the mainstay of treatment yielding limited 5-year survival rates. New treatment approaches using Docetaxel chemotherapy or androgen receptor pathway inhibitors to intensify upfront systemic therapy have resulted in significantly improved survival rates compared to androgen deprivation therapy alone. Clinicians are now equipped with an arsenal of drugs capable of prolonging life for metastatic hormone-sensitive prostate cancer patients. Furthermore, new treatment modalities are being tested in clinical trials making treatment of metastatic hormone-sensitive prostate cancer an extremely dynamic space. In this narrative review, we provide an overview of the key systemic treatments for metastatic hormone-sensitive prostate cancer, namely androgen deprivation therapy, novel androgen receptor pathway inhibitors and Docetaxel. We summarise a series of landmark trials that have led to the integration of novel androgen receptor pathway inhibitors and docetaxel into the treatment paradigm for metastatic hormone-sensitive prostate cancer. Lastly, we discuss nursing, financial and side-effect considerations pertaining to the use of these drugs. This article aims to give its readers an understanding of the evidence and clinical aspects of novel therapies in metastatic hormone-sensitive prostate cancer as they become increasingly available for use around the world.
前列腺癌仍然是全球男性中最常被诊断出的癌症之一,也是男性癌症死亡的主要原因。在过去十年中,转移性激素敏感性前列腺癌的格局发生了显著变化。多年来,单纯通过手术或药物去势进行雄激素剥夺治疗一直是主要的治疗方法,5年生存率有限。与单纯雄激素剥夺治疗相比,使用多西他赛化疗或雄激素受体通路抑制剂加强初始全身治疗的新治疗方法显著提高了生存率。临床医生现在拥有一系列能够延长转移性激素敏感性前列腺癌患者生命的药物。此外,新的治疗方式正在临床试验中进行测试,这使得转移性激素敏感性前列腺癌的治疗成为一个极具活力的领域。在这篇叙述性综述中,我们概述了转移性激素敏感性前列腺癌的关键全身治疗方法,即雄激素剥夺治疗、新型雄激素受体通路抑制剂和多西他赛。我们总结了一系列具有里程碑意义的试验,这些试验导致新型雄激素受体通路抑制剂和多西他赛被纳入转移性激素敏感性前列腺癌的治疗模式。最后,我们讨论了与这些药物使用相关的护理、经济和副作用方面的考虑因素。本文旨在让读者了解转移性激素敏感性前列腺癌新型疗法的证据和临床方面,因为这些疗法在世界各地越来越容易获得使用。