Department of Urology, University Hospital Schleswig- Holstein, Campus Lübeck, Lübeck, Germany; University Hospital of Schleswig-Holstein, Campus Lübeck and Research Center Borstel, Leibniz Lung Center, Borstel, Germany; University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Pathology, Lübeck, Germany; Department of Urology and Pediatric Urology, University Hospital Münster, Münster, Germany; Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany; Department of Radiation Oncology and Radiation Therapy, Charité Universitäts - medizin - Campus Benjamin Franklin, Berlin, Germany; Department of Uro-Oncology of the Oncology Center and the Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dtsch Arztebl Int. 2022 Sep 16;119(37):622-632. doi: 10.3238/arztebl.m2022.0294.
For many years, the standard treatment of metastatic, hormone-sensitive prostatic carcinoma (mHSPC) was androgen deprivation therapy (ADT) alone. By lowering the testosterone level into the castration range, ADT deprives the tumor of a key growth factor.
For this article, we evaluated the treatment recommendations contained in national and international guidelines (German S3 guidelines and those of the European Society for Medical Oncology [ESMO], European Association of Urology [EAU], and National Comprehensive Cancer Network [NCCN]), as well as pertinent publications revealed by a PubMed search and the congress abstracts of the ESMO and of the American Society of Clinical Oncology [ASCO].
The past few years have witnessed fundamental changes in the treatment of mHSPC. Treatment intensification with docetaxel or with the new drugs directed against the androgen receptor signal pathway (abiraterone, apalutamide and enzalutamide) has been found to lower mortality by 19-40% and is now an integral component of first-line therapy. Relevant new findings have also been obtained with threefold combinations of ADT, docetaxel, and abiraterone or darolutamide. For patients with a light tumor burden, local radiotherapy of the primary tumor improves the probability of survival at 3 years by 8% (45.4 versus 49.1 months, difference 3.6 months; 95% confidence interval, 1.0 to 6.2 months).
The treatment of mHSPC is constantly changing. Phase III trials that are now in the recruitment stage, as well as our continually improving understanding of the underlying molecular-pathological mechanisms, will be altering the treatment landscape still further in the years to come.
多年来，转移性、激素敏感性前列腺癌（mHSPC）的标准治疗方法是单独使用雄激素剥夺疗法（ADT）。通过将睾酮水平降低到去势范围，ADT 剥夺了肿瘤的一个关键生长因子。
本文评估了国家和国际指南（德国 S3 指南以及欧洲肿瘤内科学会[ESMO]、欧洲泌尿外科学会[EAU]和美国国家综合癌症网络[NCCN]的指南）中包含的治疗建议，以及通过 PubMed 搜索和 ESMO 以及美国临床肿瘤学会[ASCO]大会摘要揭示的相关出版物。
过去几年，mHSPC 的治疗方法发生了根本性变化。用多西他赛或新的抗雄激素受体信号通路药物（阿比特龙、阿帕鲁胺和恩扎鲁胺）进行治疗强化，已被证明能降低 19-40%的死亡率，现已成为一线治疗的重要组成部分。ADT、多西他赛和阿比特龙或达罗他胺三联治疗也有相关新发现。对于肿瘤负担较轻的患者，原发肿瘤的局部放疗可将 3 年生存率提高 8%（45.4 与 49.1 个月，差异 3.6 个月；95%置信区间，1.0 至 6.2 个月）。
mHSPC 的治疗方法不断变化。目前正在招募阶段的 III 期试验，以及我们对潜在分子病理机制的理解不断提高，将在未来几年进一步改变治疗格局。
