Gotto Geoffrey T, Yip Steven M, Shayegan Bobby, O'Sullivan Dylan E, Wallis Christopher J D, Basappa Naveen S, Cagiannos Ilias, Hamilton Robert J, Ferrario Cristiano, Fernandes Ricardo, Danielson Brita, Saad Fred, Hotte Sebastien J, Cheung Winson Y, Boyne Devon J, Chan Katherine, Osborne Brendan, Zardan Anousheh, Malone Shawn
Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada.
Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
Can Urol Assoc J. 2025 Jan;19(1):E25-E35. doi: 10.5489/cuaj.8691.
Treatment intensification beyond androgen deprivation therapy (ADT) has shown survival benefit in patients with metastatic castration-sensitive prostate cancer (mCSPC). There is a need to better understand how these novel treatments fit in real-world practice.
Using electronic medical records and administrative data, a population-based, retrospective cohort study of patients diagnosed with de novo mCSPC between 2010 and 2020 in Alberta, Canada, and initiated on ADT was conducted. Treatment intensification was defined as the receipt of apalutamide, abiraterone acetate, enzalutamide, or chemotherapy (e.g., docetaxel) within 180 days of ADT initiation.
A total of 2515 de novo mCSPC were identified, with 2098 (83%) patients initiating ADT post-diagnosis. Of those, 525 (25%) received intensification beyond ADT. Three percent of patients were intensified in 2010-2013; this increased to 67% in 2020. From 2014-2017, docetaxel was the most used approach, although it was supplanted by abiraterone acetate, apalutamide, and enzalutamide from 2018 onwards. In multivariable logistic regression analyses of patients diagnosed from 2014-2020, significant predictors of intensification were younger age at diagnosis, lower Charlson comorbidity index, greater number of metastatic sites, shorter time to ADT initiation, referral to a medical oncologist, transurethral resection of the prostate or radiation prior to ADT, and more recent year of diagnosis (all p<0.05).
There has been a considerable increase in the use of ADT intensification therapies that correspond with the timing of clinical trial data and approvals of novel agents.
雄激素剥夺治疗（ADT）之外的强化治疗已显示出对转移性去势敏感性前列腺癌（mCSPC）患者有生存益处。有必要更好地了解这些新型治疗方法如何适用于现实世界的实践。
利用电子病历和行政数据，对2010年至2020年在加拿大艾伯塔省被诊断为初发性mCSPC并开始接受ADT治疗的患者进行了一项基于人群的回顾性队列研究。强化治疗定义为在开始ADT治疗后的180天内接受阿帕他胺、醋酸阿比特龙、恩杂鲁胺或化疗（如多西他赛）。
共识别出2515例初发性mCSPC患者，其中2098例（83%）在诊断后开始接受ADT治疗。在这些患者中，525例（25%）接受了ADT之外的强化治疗。2010 - 2013年，3%的患者接受了强化治疗；到2020年，这一比例增至67%。2014 - 2017年，多西他赛是最常用的治疗方法，不过从2018年起，它被醋酸阿比特龙、阿帕他胺和恩杂鲁胺所取代。在对2014 - 2020年诊断的患者进行的多变量逻辑回归分析中，强化治疗的显著预测因素包括诊断时年龄较小、Charlson合并症指数较低、转移部位数量较多、开始ADT治疗的时间较短、转诊至医学肿瘤学家、在ADT治疗前进行经尿道前列腺切除术或放疗以及诊断年份较近（所有p<0.05）。
ADT强化治疗的使用有了显著增加，这与临床试验数据的时间以及新型药物的获批情况相符。
