Rahman Syed N, Kim Hyung Suk, Webb Lindsey T, Diaz Gabriela M, Leapman Michael S, Sprenkle Preston C, Brito Joseph M, Renzulli Joseph, Martin Thomas V, Kenney Patrick, Kim Isaac Yi
Department of Urology, Yale School of Medicine, New Haven, CT, USA.
Department of Urology, Dongguk University School of Medicine, Dongguk University Ilsan Medical Center, Goyang-si, Korea.
Transl Cancer Res. 2024 Nov 30;13(11):6473-6488. doi: 10.21037/tcr-24-245. Epub 2024 Jul 16.
Radiation- (radio-)recurrent prostate cancer poses a significant challenge in clinical management due to its complexity and varied treatment responses. The recurrence of prostate cancer following radiotherapy necessitates a nuanced management strategy that considers disease stage and aggressiveness, patient health status, and prior treatment modalities. Androgen deprivation therapy (ADT), a cornerstone in the management of regional or distant relapse, often initiates the therapeutic cascade, effectively suppressing tumor growth by targeting androgen signaling. Second-line antiandrogen therapies such as abiraterone and enzalutamide, in conjunction with ADT, exhibit considerable clinical efficacy by delaying disease progression and ameliorating symptoms. However, in the absence of regional or distant disease, local relapse after radiation may be best managed with local salvage therapy. Salvage radical prostatectomy (SRP) may be considered in select cases of local recurrence, providing a potentially curative option. Salvage radiation therapy (RT), such as stereotactic body RT (SBRT), low-dose-rate (LDR), or high-dose-rate (HDR) brachytherapy (BT) is another viable option for localized recurrences. Other local treatments, such as cryotherapy, high-intensity focused ultrasound (HIFU) and irreversible electroporation (IRE) have been applied as salvage local therapy for radio-recurrent prostate cancer with promising results. Notwithstanding, exploring new avenues for improved outcomes and personalized treatment strategies as well as clinical trials investigating novel therapeutic agents and combination therapies remain imperative for these men. This comprehensive review aims to examine the current landscape of therapeutic approaches and emerging strategies for managing radio-recurrent prostate cancer.
放射性（放射-）复发性前列腺癌因其复杂性和多样的治疗反应，在临床管理中构成了重大挑战。放射治疗后前列腺癌的复发需要一种细致入微的管理策略，该策略要考虑疾病阶段和侵袭性、患者健康状况以及先前的治疗方式。雄激素剥夺疗法（ADT）是局部或远处复发管理的基石，通常启动治疗级联反应，通过靶向雄激素信号传导有效抑制肿瘤生长。阿比特龙和恩杂鲁胺等二线抗雄激素疗法与ADT联合使用，通过延缓疾病进展和改善症状展现出相当大的临床疗效。然而，在不存在局部或远处疾病的情况下，放射治疗后的局部复发可能最好采用局部挽救性治疗。在某些局部复发的病例中可考虑挽救性根治性前列腺切除术（SRP），这提供了一种潜在的治愈选择。挽救性放射治疗（RT），如立体定向体部放射治疗（SBRT）、低剂量率（LDR）或高剂量率（HDR）近距离放射治疗（BT）是局部复发的另一种可行选择。其他局部治疗方法，如冷冻疗法、高强度聚焦超声（HIFU）和不可逆电穿孔（IRE）已被用作放射性复发性前列腺癌的挽救性局部治疗，效果良好。尽管如此，探索改善治疗结果的新途径和个性化治疗策略以及研究新型治疗药物和联合疗法的临床试验对这些患者来说仍然至关重要。这篇综述旨在探讨放射性复发性前列腺癌治疗方法的现状和新兴策略。
