Department of Urology, Singapore General Hospital, Singapore, Singapore.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
World J Urol. 2023 Aug;41(8):2021-2031. doi: 10.1007/s00345-022-04135-8. Epub 2022 Aug 27.
The landscape of advanced prostate cancer treatment has evolved tremendously in past decades. The treatment paradigm has shifted from androgen deprivation therapy (ADT) alone to doublet combinations comprising ADT with docetaxel or an androgen receptor inhibitor, and now triplet therapy involving all 3 classes of agents. Robust clinical data has demonstrated survival benefits with this strategy of upfront treatment intensification. Subgroup analysis has alluded to the importance of tailoring treatment according to metastatic disease burden. However, defining the volume of disease is becoming increasingly controversial due to the advent of next generation molecular imaging. Several trials testing established agents in the castrate-resistant setting are now underway in metastatic hormone sensitive prostate cancer patients. As the treatment milieu is enriched earlier in the disease trajectory, future studies should elucidate biomarkers to further define specific patient populations who will benefit most from treatment intensification and/or de-escalation, with what agents and for what duration.
在过去几十年中，晚期前列腺癌的治疗格局发生了巨大变化。治疗模式已经从单独的雄激素剥夺疗法（ADT）转变为包含 ADT 联合多西他赛或雄激素受体抑制剂的双联组合，现在又发展为包括所有 3 类药物的三联疗法。强有力的临床数据表明，这种强化治疗策略具有生存获益。亚组分析提示，根据转移性疾病负担来调整治疗方案非常重要。然而，由于下一代分子成像技术的出现，定义疾病的范围变得越来越有争议。目前正在转移性激素敏感前列腺癌患者中进行几项试验，以测试在去势抵抗环境中使用已确立药物的疗效。随着治疗环境在疾病进程中更早地得到改善，未来的研究应该阐明生物标志物，以进一步确定最受益于强化治疗和/或降级治疗、使用何种药物以及治疗时间的特定患者群体。
