Hiroshi Masuda
Department of Urology and Prostate Disease Center, Chiba Rosai Hospital, Chiba, Japan.
Cancer Diagn Progn. 2024 Nov 3;4(6):684-688. doi: 10.21873/cdp.10382. eCollection 2024 Nov-Dec.
Androgen-deprivation therapy is an extremely effective treatment for progressive prostate cancer. Previously, the first-line treatment for progressive prostate cancer was combined androgen blockade (CAB). If the disease progressed to castration-resistant prostate cancer, the administration of androgen receptor signaling inhibitors (ARSIs) was recommended. When elevated serum prostate-specific antigen (PSA) levels are seen during CAB treatment, it is important to suspect antiandrogen withdrawal syndrome (AWS), discontinue CAB, and monitor the changes in the serum PSA levels. If a reduction in the patient's PSA levels is subsequently observed, antiandrogens should be discontinued and the patient should be followed, but if their PSA level rises they should be transitioned to ARSI treatment. Recently, there have been reports of withdrawal syndrome (WS) after ARSI treatment. With the increased use of ARSIs, such as abiraterone acetate, enzalutamide, apalutamide, and dalorutamide, it is necessary to consider ARSI WS when a patient's serum PSA level increases during ARSI treatment. Unnecessary treatment can be avoided if the confirmation of ARSI WS is prioritized. Conversely, if it is not confirmed there is a risk that second-line treatment will be delayed. This is a review of recent studies of ARSI WS. It also discusses future prospects in this field.
雄激素剥夺疗法是治疗进展性前列腺癌的一种极其有效的方法。以前，进展性前列腺癌的一线治疗是联合雄激素阻断（CAB）。如果疾病进展为去势抵抗性前列腺癌，则推荐使用雄激素受体信号抑制剂（ARSIs）。在CAB治疗期间，如果血清前列腺特异性抗原（PSA）水平升高，怀疑抗雄激素撤药综合征（AWS）、停用CAB并监测血清PSA水平的变化很重要。如果随后观察到患者PSA水平降低，应停用抗雄激素药物并对患者进行随访，但如果其PSA水平升高，则应转为ARSIs治疗。最近，有关于ARSIs治疗后出现撤药综合征（WS）的报道。随着醋酸阿比特龙、恩杂鲁胺、阿帕鲁胺和达罗他胺等ARSIs的使用增加，当患者在ARSIs治疗期间血清PSA水平升高时，有必要考虑ARSIs WS。如果优先确认ARSIs WS，可以避免不必要的治疗。相反，如果未得到确认，则存在二线治疗延迟的风险。这是对ARSIs WS近期研究的综述。它还讨论了该领域的未来前景。
