Terlizzi Mario, Limkin Elaine Johanna, Moukasse Yasmina, Blanchard Pierre
Radiation Oncology Department, Institute Gustave Roussy, 94805 Villejuif, France.
Cancers (Basel). 2022 Mar 26;14(7):1688. doi: 10.3390/cancers14071688.
Nearly one-third of the patients who undergo prostatectomy for prostate cancer have a biochemical recurrence (BCR) during follow-up. While several randomized trials have shown that adjuvant radiation therapy (aRT) improves biochemical control, this strategy has not been widely used because of the risk of toxicity and the fear of overtreating patients who would not have relapsed. In addition, the possibility of close PSA monitoring in the era of ultrasensitive assays enables to anticipate early salvage strategies (sRT). Three recent randomized trials and their meta-analysis have confirmed that aRT does not improve event-free survival compared to sRT, imposing the latter as the new standard of treatment. The addition of androgen deprivation therapy (ADT) to RT has been shown to improve biochemical control and metastasis-free survival, but the precise definition of to whom it should be proposed is still a matter of debate. The development of genomic tests or the use of artificial intelligence will allow more individualized treatment in the future. Therapeutic intensification with the combination of new-generation hormone therapy and RT is under study. Finally, the growing importance of metabolic imaging (PET/CT) due to its performance especially for low PSA levels will help in further personalizing management strategies.
接受前列腺癌前列腺切除术的患者中，近三分之一在随访期间出现生化复发（BCR）。虽然多项随机试验表明，辅助放疗（aRT）可改善生化控制，但由于存在毒性风险以及担心对不会复发的患者进行过度治疗，该策略尚未得到广泛应用。此外，在超灵敏检测时代，密切监测PSA的可能性使得早期挽救性治疗策略（sRT）成为可能。最近的三项随机试验及其荟萃分析证实，与sRT相比，aRT并不能改善无事件生存期，从而使sRT成为新的治疗标准。在放疗中加入雄激素剥夺治疗（ADT）已被证明可改善生化控制和无转移生存期，但对于应将其应用于哪些患者的确切定义仍存在争议。基因组检测的发展或人工智能的应用将使未来的治疗更加个性化。新一代激素疗法与放疗联合的强化治疗正在研究中。最后，代谢成像（PET/CT）因其性能，特别是对低PSA水平的检测能力日益重要，这将有助于进一步优化个性化管理策略。
