Brönimann Stephan, Singla Nirmish, Korn Stephan M, Huebner Nicolai A, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Memo. 2024 Feb;17(1):40-44. doi: 10.1007/s12254-023-00934-w. Epub 2024 Jan 16.
Metastatic hormone-sensitive prostate cancer (mHSPC) displays both simultaneous and sequential patterns of metastasis, emphasizing a comprehensive treatment approach that integrates both local therapy and systemic treatment strategies. The increasing use of molecular imaging has led to a rise in mHSPC diagnoses, underscoring the importance of identifying the right patient population and effective treatment concepts for this disease state.
Two prospective trials, HORRAD and STAMP EDE, investigated prostate radiotherapy (RT) for mHSPC; however, they did not show an overall survival (OS) benefit in the unselected cohort. Nonetheless, RT showed favorable outcomes in patients with fewer than five bone metastases, resulting in a 7% 3-year survival improvement and supporting the integration of RT in multimodal treatment for men with oligometastatic mHSPC. Regarding cytoreductive prostatectomy (cRP), the TRoMbone Trial confirmed its feasibility and safety. In addition, findings from the FUSCC-OMPCa Trial demonstrated improved 3-year radiographic progression-free survival and OS rates with acceptable rates of complications and incontinence. Recent data from the LoMP registry have further supported superior OS and cancer-specific survival (CSS) in patients undergoing cRP compared to systemic therapy alone. Notably, no significant differences in OS and CSS were observed between the cRP and RT groups. However, cRP-treated patients exhibited superior 2-year local event-free survival when compared to those treated with RT.
RT in combination with systemic therapy remains the established first-line treatment for low-burden mHSPC, though the exact definition of low metastatic burden remains contentious. Precise assessment of metastatic burden is vital to identify patients who would derive the greatest benefit from RT. As treatment paradigms evolve, embracing multimodal approaches holds potential for optimizing outcomes in patients with mHSPC. Further research is needed to solidify the role of cRP as a standard therapeutic approach and to refine treatment strategies for improved patient outcomes.
转移性激素敏感性前列腺癌（mHSPC）呈现出同时性和序贯性转移模式，强调了一种将局部治疗和全身治疗策略相结合的综合治疗方法。分子影像学的使用日益增加，导致mHSPC诊断数量上升，凸显了识别适合该疾病状态的正确患者群体和有效治疗理念的重要性。
两项前瞻性试验，即HORRAD和STAMP EDE，研究了mHSPC的前列腺放疗（RT）；然而，在未筛选的队列中，它们并未显示出总生存期（OS）获益。尽管如此，RT在骨转移少于五处的患者中显示出良好的结果，使3年生存率提高了7%，并支持将RT纳入寡转移mHSPC男性的多模式治疗中。关于减瘤性前列腺切除术（cRP），TRoMbone试验证实了其可行性和安全性。此外，FUSCC - OMPCa试验的结果表明，3年影像学无进展生存期和OS率有所改善，并发症和尿失禁发生率可接受。LoMP注册中心的最新数据进一步支持了与单纯全身治疗相比，接受cRP治疗的患者具有更好的OS和癌症特异性生存期（CSS）。值得注意的是，cRP组和RT组之间在OS和CSS方面未观察到显著差异。然而，与接受RT治疗的患者相比，接受cRP治疗的患者在2年局部无事件生存期方面表现更优。
RT联合全身治疗仍然是低负荷mHSPC既定的一线治疗方法，尽管低转移负荷的确切定义仍存在争议。准确评估转移负荷对于识别能从RT中获得最大益处的患者至关重要。随着治疗模式的演变，采用多模式方法有望优化mHSPC患者的治疗结果。需要进一步研究以巩固cRP作为标准治疗方法的作用，并完善治疗策略以改善患者预后。
