Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Eur Urol Oncol. 2022 Aug;5(4):377-387. doi: 10.1016/j.euo.2022.04.009. Epub 2022 May 28.
Several studies have investigated selection and sequencing of systemic agents to manage recurrent prostate cancer following local definitive treatment.
To define the incidence of recurrent prostate cancer in different countries, and systematically review management options and efficacy of first-line systemic therapies for patients with prostate cancer previously treated with definitive radical prostatectomy or radiation therapy.
We performed a systematic review of studies published from January 2010 to December 2021 in MEDLINE, EMBASE, or ClinicalTrials.gov according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Quality was assessed using the Grades of Recommendation, Assessment, Development and Evaluation methodology. The potential regional burdens of recurrent prostate cancer were estimated by analyzing various regional registry data.
A total of 40 studies met the inclusion criteria and an additional landmark study published after the query was included in this review. Patients with metastatic recurrent disease derive benefit from the addition of androgen receptor signaling inhibitors to androgen deprivation therapy, while docetaxel should be reserved for patients with a high-volume metastatic burden by conventional imaging. Patients with biochemical-only recurrent disease benefit from continuous or intermittent androgen deprivation therapy if they possess high-risk features such as short prostate-specific antigen doubling time or high serum prostate-specific antigen. Current limitations to the published literature include no consideration of contemporary positron emission tomography imaging for evaluating metastatic recurrence or burden and few quality of life assessments.
This systematic review summarizes the findings and recommendations for first-line systemic therapy for patients with recurrent prostate cancer following local therapy.
We performed a systematic evaluation and summary of all studies published within the past decade on the topic of medications used to treat prostate cancer after it has recurred following radiation therapy or surgery. This review can be used to inform guidelines for prostate cancer management.
多项研究已经探讨了在局部根治性治疗后管理复发性前列腺癌时系统性药物的选择和序贯治疗。
定义不同国家复发性前列腺癌的发生率，并系统地回顾先前接受根治性前列腺切除术或放射治疗的前列腺癌患者的一线全身治疗方案的管理选择和疗效。
我们根据系统评价和荟萃分析的首选报告项目，对 2010 年 1 月至 2021 年 12 月在 MEDLINE、EMBASE 或 ClinicalTrials.gov 发表的研究进行了系统评价。使用推荐分级、评估、制定和评价方法评估质量。通过分析各种区域登记数据来估计复发性前列腺癌的潜在区域负担。
共有 40 项研究符合纳入标准，本综述还纳入了一项在查询后发表的标志性研究。对于转移性复发性疾病患者，雄激素受体信号抑制剂联合雄激素剥夺治疗可获益，而对于通过常规影像学检查具有高容量转移负担的患者，应保留多西他赛治疗。对于仅生化复发的患者，如果具有高风险特征，如前列腺特异性抗原倍增时间短或血清前列腺特异性抗原高，则连续或间歇性雄激素剥夺治疗可获益。目前发表的文献存在一些局限性，包括未考虑用于评估转移性复发或负担的当代正电子发射断层扫描成像，以及缺乏生活质量评估。
本系统评价总结了局部治疗后复发性前列腺癌患者一线全身治疗的发现和建议。
我们对过去十年中所有关于在放射治疗或手术后前列腺癌复发后使用药物治疗前列腺癌的研究进行了系统评估和总结。该综述可用于为前列腺癌管理提供指南。
