Salgado Carla Manzoni, Garcia-Perdomo Herney Andrés, Reis Leonardo O
Urology and Oncology, Center for Life Sciences, Pontifical Catholic University of Campinas-PUC-Campinas, Av. John Boyd Dunlop, Unnumbered | Jd. Ipaussurama, Campinas, SP, 13060-904, Brazil.
School of Medicine, Universidad del Valle, UROGIV Research Group, Cali, Colombia.
Int Urol Nephrol. 2022 Jun;54(6):1187-1192. doi: 10.1007/s11255-022-03201-9. Epub 2022 Apr 6.
Advanced prostate cancer does not respond to traditional androgen deprivation therapy (ADT) at some point in the treatment. The development of new hormonal agents demonstrated clear efficacy and changed the treatment scenario.
To evaluate the use of new antiandrogens alone versus their use in combination with maintenance ADT in patients with advanced castration-resistant prostate cancer.
A literature systematic review of randomized clinical trials, cohorts, and real-life studies including patients who received the new antiandrogens with or without ADT due to histologic confirmed advanced castration-resistant prostate adenocarcinoma was carried out.
2181 articles were identified and three studies were included with a total of 246 patients. Two studies were randomized clinical trials, and the third was a retrospective study, which showed similar results for both arms, in relation to PSA response, radiological progression-free survival, and testosterone levels, in addition to cost analysis with savings avoided in the ADT maintenance-free arm. Despite the positive data, it is still not possible to categorically state whether there is a statistical benefit in suspending the ADT during the use of new antiandrogens, due to the heterogeneity of the studies.
The literature is limited on the issue. Available data are still immature with no clear benefit of the use of newer antiandrogens alone in the setting of advanced castration-resistant prostate cancer.
晚期前列腺癌在治疗的某个阶段对传统雄激素剥夺疗法（ADT）无反应。新型激素药物的研发显示出明确疗效并改变了治疗局面。
评估新型抗雄激素药物单独使用与联合维持性ADT在晚期去势抵抗性前列腺癌患者中的应用情况。
对随机临床试验、队列研究和真实世界研究进行文献系统综述，纳入因组织学确诊为晚期去势抵抗性前列腺腺癌而接受或未接受ADT的新型抗雄激素药物治疗的患者。
共识别出2181篇文章，纳入三项研究，共计246例患者。两项为随机临床试验，第三项为回顾性研究，结果显示两组在前列腺特异性抗原（PSA）反应、影像学无进展生存期和睾酮水平方面相似，此外还进行了成本分析，结果显示不进行ADT维持治疗的组节省了费用。尽管有这些阳性数据，但由于研究的异质性，仍无法明确指出在使用新型抗雄激素药物期间暂停ADT是否具有统计学益处。
关于该问题的文献有限。现有数据仍不成熟，在晚期去势抵抗性前列腺癌的情况下，单独使用新型抗雄激素药物尚无明确益处。
