O'Loughlin Lauren, Abel Melissa L, Madan Ravi A, Einstein David J
Division of Medical Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA.
Curr Oncol Rep. 2025 Mar;27(3):247-257. doi: 10.1007/s11912-025-01647-5. Epub 2025 Feb 22.
We evaluate unique clinical and drug development challenges in biochemically recurrent (BCR) prostate cancer. We examine risk stratification, critically appraise trials, and outline ongoing and future development of hormonal and non-hormonal options. We provide guidance for patient communication and examine how trial design may or may not reflect patient values.
EMBARK established a potential role for enzalutamide with or without androgen deprivation therapy for certain patients with BCR, but questions remain about the study design and optimal usage. BCR is a heterogeneous condition with generally favorable long-term outcomes. Hormonal therapies are highly effective in suppressing-but not curing-micrometastatic disease, and are also highly effective when reserved for macrometastases, following surveillance. Ongoing studies are examining whether hormonal therapies add to metastasis-directed therapies and whether non-hormonal therapies may offer alternatives or combinations. Careful attention to trial design and endpoints will be essential for accurately measuring benefits and trade-offs.
我们评估生化复发（BCR）前列腺癌在临床和药物研发方面面临的独特挑战。我们研究风险分层，批判性地评估试验，并概述激素和非激素治疗方案的当前及未来发展情况。我们为医患沟通提供指导，并探讨试验设计如何反映或未反映患者价值观。
EMBARK研究确定了恩杂鲁胺联合或不联合雄激素剥夺疗法在某些BCR患者中的潜在作用，但研究设计和最佳用法仍存在疑问。BCR是一种异质性疾病，总体长期预后良好。激素疗法在抑制微转移疾病方面非常有效，但无法治愈，在监测后用于大转移灶时也非常有效。正在进行的研究正在探讨激素疗法是否能增强转移导向疗法，以及非激素疗法是否可提供替代方案或联合治疗。仔细关注试验设计和终点对于准确衡量获益和权衡至关重要。
