Reitano Giuseppe, Ceccato Tommaso, Botti Simone, Bruniera Martina, Carrozza Salvatore, Bovolenta Eleonora, Randazzo Gianmarco, Minardi Davide, Ruggera Lorenzo, Gardi Mario, Novara Giacomo, Dal Moro Fabrizio, Zattoni Fabio
Department of Urology, Azienda Ospedale-Università Padova, 35122 Padova, Italy.
Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
Cancers (Basel). 2024 Jul 5;16(13):2465. doi: 10.3390/cancers16132465.
The management of high-risk prostate cancer (PCa) presents a significant clinical challenge, often necessitating treatment intensification due to the potential presence of micrometastases. While radical prostatectomy (RP) constitutes one of the primary treatment modalities, the integration of neoadjuvant and adjuvant therapies suggests a paradigm shift towards more aggressive treatment strategies, also guided by new imaging modalities like positron emission tomography using prostate-specific membrane antigen (PSMA-PET). Despite the benefits, treatment intensification raises concerns regarding increased side effects. This review synthesizes the latest evidence on perioperative treatment intensification and de-escalation for high-risk localized and locally advanced PCa patients eligible for surgery. Through a non-systematic literature review conducted via PubMed, Scopus, Web of Science, and ClinicalTrials.gov, we explored various dimensions of perioperative treatments, including neoadjuvant systemic therapies, adjuvant therapies, and the role of novel diagnostic technologies. Emerging evidence provides more support for neoadjuvant systemic therapies. Preliminary results from studies suggest the potential for treatments traditionally reserved for metastatic PCa to show apparent benefit in a non-metastatic setting. The role of adjuvant treatments remains debated, particularly the use of androgen deprivation therapy (ADT) and adjuvant radiotherapy in patients at higher risk of biochemical recurrence. The potential role of radio-guided PSMA lymph node dissection emerges as a cutting-edge approach, offering a targeted method for eradicating disease with greater precision. Innovations such as artificial intelligence and machine learning are potential game-changers, offering new avenues for personalized treatment and improved prognostication. The intensification of surgical treatment in high-risk PCa patients is a dynamic and evolving field, underscored by the integration of traditional and novel therapeutic approaches. As evidence continues to emerge, these strategies will refine patient selection, enhance treatment efficacy, and mitigate the risk of progression, although with an attentive consideration of the associated side effects.
高危前列腺癌（PCa）的管理面临重大临床挑战，由于可能存在微转移，通常需要强化治疗。虽然根治性前列腺切除术（RP）是主要治疗方式之一，但新辅助和辅助治疗的整合表明治疗策略正朝着更积极的方向转变，这也受到正电子发射断层扫描等新成像模式的指导，例如使用前列腺特异性膜抗原（PSMA-PET）的正电子发射断层扫描。尽管有这些益处，但强化治疗引发了对副作用增加的担忧。本综述综合了关于符合手术条件的高危局限性和局部晚期PCa患者围手术期治疗强化和降级的最新证据。通过在PubMed、Scopus、Web of Science和ClinicalTrials.gov上进行的非系统性文献综述，我们探讨了围手术期治疗的各个方面，包括新辅助全身治疗、辅助治疗以及新型诊断技术的作用。新出现的证据为新辅助全身治疗提供了更多支持。研究的初步结果表明，传统上用于转移性PCa的治疗方法在非转移性情况下可能显示出明显益处。辅助治疗的作用仍存在争议，特别是在生化复发风险较高的患者中使用雄激素剥夺疗法（ADT）和辅助放疗。放射性引导的PSMA淋巴结清扫术的潜在作用成为一种前沿方法，提供了一种更精确地根除疾病的靶向方法。人工智能和机器学习等创新可能会带来变革，为个性化治疗和改善预后提供新途径。高危PCa患者手术治疗的强化是一个动态发展的领域，传统和新型治疗方法的整合凸显了这一点。随着证据不断涌现，这些策略将优化患者选择、提高治疗效果并降低疾病进展风险，不过要密切关注相关的副作用。
