Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
Comb Chem High Throughput Screen. 2024;27(17):2598-2608. doi: 10.2174/0113862073266959231114052928.
The treatment of metastatic castration-resistant prostate cancer (mCRPC) in the actual world currently presents difficulties. In light of this, it is crucial to investigate high-risk factors for the progression of advanced prostate cancer and to identify methods for delaying the onset of CRPC.
This study aimed to explore the high-risk factors that impact the progression of prostate cancer and emphasize the significance of precise diagnosis and treatment based on etiological classification in the clinical management of castration-resistant prostate cancer.
A retrospective analysis was conducted on 277 newly diagnosed cases of PCa treated with endocrine therapy. A follow-up was done on prostate-specific antigen (PSA) levels and testosterone. Additionally, a prospective analysis was performed on the clinical data of 60 patients with CRPC. Following the principle of "4W1H", 30 patients were included in the precision treatment group for a second biopsy and related tests, while another 30 patients were included in the conventional treatment group. The therapeutic effect and prognosis of the two groups were observed.
Distant metastasis (HR = 1.879, 95% CI: 1.311 ~ 2.694, P = 0.001), PSA nadir > 0.2 ng/mL (HR = 1.843, 95% CI: 1.338 ~ 2.540, P = 0.001), testosterone nadir > 20 ng/dL (HR = 1.403, 95% CI: 1.035 ~ 1.904, P = 0.029), and time to testosterone nadir > 6 months (HR = 1.919, 95% CI: 1.364 ~ 2.701, P = 0.001) were risk factors for the progression to CRPC. Patients in the CRPC group were treated with precision therapy and conventional therapy based on their molecular subtyping. The precision treatment group showed a significantly prolonged median PSA progression-free survival compared to the conventional treatment group (16.0 months vs. 13.0 months, P=0.025). The median radiographic progression-free survival was also significantly extended in the precision treatment group compared to the conventional treatment group (21.0 months vs. 16.0 months, P=0.042).
Patients with prostate cancer diagnosed with distant metastasis at initial presentation require early intervention. Close monitoring of PSA and serum testosterone changes is necessary during the process of endocrine therapy. After entering the CRPC stage, the etiological classification precision treatment can improve the therapeutic effect and improve the prognosis of patients.
转移性去势抵抗性前列腺癌（mCRPC）的实际治疗目前存在困难。有鉴于此，探讨影响晚期前列腺癌进展的高危因素，寻找延缓 CRPC 发生的方法至关重要。
本研究旨在探讨影响前列腺癌进展的高危因素，并强调在去势抵抗性前列腺癌的临床管理中，基于病因分类进行精准诊断和治疗的重要性。
对 277 例接受内分泌治疗的新诊断 PCa 患者进行回顾性分析。对前列腺特异性抗原（PSA）水平和睾酮进行随访。此外，对 60 例 CRPC 患者的临床资料进行前瞻性分析。按照“4W1H”原则，30 例患者纳入精准治疗组进行二次活检和相关检查，另 30 例患者纳入常规治疗组。观察两组的治疗效果和预后。
远处转移（HR=1.879，95%CI：1.3112.694，P=0.001）、PSA 最低值>0.2ng/mL（HR=1.843，95%CI：1.3382.540，P=0.001）、睾酮最低值>20ng/dL（HR=1.403，95%CI：1.0351.904，P=0.029）和睾酮最低值达峰时间>6 个月（HR=1.919，95%CI：1.3642.701，P=0.001）是进展为 CRPC 的危险因素。CRPC 组患者根据分子亚型进行精准治疗和常规治疗。与常规治疗组相比，精准治疗组的中位 PSA 无进展生存期显著延长（16.0 个月比 13.0 个月，P=0.025）。与常规治疗组相比，精准治疗组的中位影像学无进展生存期也显著延长（21.0 个月比 16.0 个月，P=0.042）。
初诊时即诊断为远处转移的前列腺癌患者需要早期干预。内分泌治疗过程中需密切监测 PSA 和血清睾酮变化。进入 CRPC 阶段后，病因分类精准治疗可提高治疗效果，改善患者预后。
