Matsukawa Akihiro, Yanagisawa Takafumi, Fazekas Tamas, Miszczyk Marcin, Tsuboi Ichiro, Kardoust Parizi Mehdi, Laukhtina Ekaterina, Klemm Jakob, Mancon Stefano, Mori Keiichiro, Kimura Shoji, Miki Jun, Gomez Rivas Juan, Soeterik Timo F W, Zilli Thomas, Tilki Derya, Joniau Steven, Kimura Takahiro, Shariat Shahrokh F, Rajwa Pawel
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Prostate Cancer Prostatic Dis. 2024 Sep 13. doi: 10.1038/s41391-024-00890-4.
Recent advancements in the management of biochemical recurrence (BCR) following local treatment for prostate cancer (PCa), including the use of androgen receptor signaling inhibitors (ARSIs), have broadened the spectrum of therapeutic options. We aimed to compare salvage therapies in patients with BCR after definitive local treatment for clinically non-metastatic PCa with curative intent.
In October 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled trials (RCTs) and prospective studies reporting data on the efficacy of salvage therapies in PCa patients with BCR after radical prostatectomy (RP) or radiation therapy (RT). The primary endpoint was metastatic-free survival (MFS), and secondary endpoints included progression-free survival (PFS) and overall survival (OS).
We included 19 studies (n = 9117); six trials analyzed RT-based strategies following RP, ten trials analyzed hormone-based strategies following RP ± RT or RT alone, and three trials analyzed other agents. In a pairwise meta-analysis, adding hormone therapy to salvage RT significantly improved MFS (HR: 0.69, 95% CI: 0.57-0.84, p < 0.001) compared to RT alone. Based on treatment ranking analysis, among RT-based strategies, the addition of elective nodal RT and androgen deprivation therapy (ADT) was found to be the most effective in terms of MFS. On the other hand, among hormone-based strategies, enzalutamide + ADT showed the greatest benefit for both MFS and OS.
The combination of prostate bed RT, elective pelvic irradiation, and ADT is the preferred treatment for eligible patients with post-RP BCR based on our analysis. In remaining patients, or in case of post-RT recurrence, especially for those with high-risk BCR, the combination of ADT and ARSI should be considered.
前列腺癌（PCa）局部治疗后生化复发（BCR）管理方面的最新进展，包括雄激素受体信号抑制剂（ARSIs）的使用，拓宽了治疗选择范围。我们旨在比较针对临床非转移性PCa进行根治性局部治疗后出现BCR的患者的挽救性治疗方法。
2023年10月，我们检索了PubMed、Scopus和Web of Science数据库，以识别随机对照试验（RCT）和前瞻性研究，这些研究报告了根治性前列腺切除术（RP）或放射治疗（RT）后BCR的PCa患者挽救性治疗疗效的数据。主要终点是无转移生存期（MFS），次要终点包括无进展生存期（PFS）和总生存期（OS）。
我们纳入了19项研究（n = 9117）；6项试验分析了RP后基于RT的策略，10项试验分析了RP±RT或单独RT后基于激素的策略，3项试验分析了其他药物。在一项成对荟萃分析中，与单独RT相比，在挽救性RT中添加激素治疗显著改善了MFS（HR：0.69，95%CI：0.57 - 0.84，p < 0.001）。基于治疗排名分析，在基于RT的策略中，就MFS而言，添加选择性淋巴结RT和雄激素剥夺治疗（ADT）被发现是最有效的。另一方面，在基于激素的策略中，恩杂鲁胺 + ADT对MFS和OS均显示出最大益处。
根据我们的分析，前列腺床RT、选择性盆腔照射和ADT的联合是RP后BCR合格患者的首选治疗方法。在其余患者中，或在RT后复发的情况下，特别是对于那些高危BCR患者，应考虑ADT和ARSI的联合使用。
