Mitsogianni Maria, Papatsoris Athanasios, Bala Vanessa-Meletia, Issa Hussein, Moussa Mohammad, Mitsogiannis Iraklis
4th Department of Medical Oncology, Hygeia Hospital, Athens, Greece.
2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Expert Opin Pharmacother. 2023 Sep-Dec;24(16):1765-1774. doi: 10.1080/14656566.2023.2244415. Epub 2023 Aug 7.
Prostate cancer is the most common malignancy in the male. Androgen-deprivation therapy (ADT) has been the mainstay in the treatment of metastatic prostate cancer however, due to the outgrowth of castration-resistant cell population the disease inevitably progresses to an aggressive, difficult to handle stage.
We have reviewed the literature regarding hormonal-directed therapy prostate cancer. New agents, namely abiraterone acetate, combined with prednisone, and next generation antiandrogens (enzalutamide, apalutamide and darolutamide) have shown considerable efficacy, not only in patients with metastatic but also in those with non-metastatic disease, either castration resistant (CRPC) or hormone sensitive (HSPC).
The addition of abiraterone and of the second-generation antiandrogens to our therapeutic armamentarium has improved prognosis ofprostate cancer in the last decade. Abiraterone is a viable option in patients with metastatic disease (hormone-sensitive and castration-resistant), whereas all next-generation antiandrogens have demonstrated efficacy in terms of metastasis-free and overall survival in non-metastatic CRPC. In addition, enzalutamide has also been found efficacious in mCRPC and mHSPC, while apalutamide in mHSPC. Currently there are no reliable data to indicate a potential superiority of one of these agents over the others in CRPC or HSPC as there are no relevant head to head studies . Sequencing hormone treatment modalities, chemotherapies and immunotherapies have not reached a consensus as yet. Randomized controlled trials are warranted to clearly define the role of novel antiandrogens in the treatment of prostate cancer. The choice of treatment should be individualized following discussion with the patient .
前列腺癌是男性中最常见的恶性肿瘤。雄激素剥夺疗法（ADT）一直是转移性前列腺癌治疗的主要手段，然而，由于去势抵抗性细胞群体的出现，该疾病不可避免地进展到侵袭性、难以处理的阶段。
我们回顾了关于激素导向疗法治疗前列腺癌的文献。新型药物，即醋酸阿比特龙联合泼尼松，以及新一代抗雄激素药物（恩杂鲁胺、阿帕他胺和达罗他胺）已显示出相当的疗效，不仅对转移性患者有效，而且对非转移性疾病患者也有效，无论是去势抵抗性（CRPC）还是激素敏感性（HSPC）。
在过去十年中，将阿比特龙和第二代抗雄激素药物添加到我们的治疗药物库中改善了前列腺癌的预后。阿比特龙是转移性疾病（激素敏感性和去势抵抗性）患者的一个可行选择，而所有新一代抗雄激素药物在非转移性CRPC的无转移生存期和总生存期方面均显示出疗效。此外，恩杂鲁胺在mCRPC和mHSPC中也被发现有效，而阿帕他胺在mHSPC中有效。目前没有可靠数据表明这些药物中的一种在CRPC或HSPC中相对于其他药物具有潜在优势，因为没有相关的直接对比研究。激素治疗方式、化疗和免疫治疗的排序尚未达成共识。需要进行随机对照试验以明确新型抗雄激素药物在前列腺癌治疗中的作用。治疗选择应在与患者讨论后个体化。
