Smani Shayan, DuBois Julien, Ajjawi Ismail, Sohoni Nishan, Choksi Ankur U, Lokeshwar Soum D, Kim Isaac Y, Renzulli Joseph F
Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA.
J Clin Med. 2025 Apr 8;14(8):2565. doi: 10.3390/jcm14082565.
Metastatic hormone-sensitive prostate cancer (mHSPCa) presents de novo or represents significant disease progression and requires systemic treatment. However, progression to castration resistance is inevitable. The treatment landscape has evolved with the introduction of intensified systemic therapy, including androgen deprivation therapy (ADT) combined with either androgen receptor signaling inhibitors (ARSIs) or cytotoxic chemotherapy (doublet therapy) or combined therapy with both agents (triplet therapy). Landmark trials such as CHAARTED, STAMPEDE, LATITUDE, ENZAMET, and TITAN have established combination therapies as the standard of care, demonstrating significant overall survival benefits. More recently, triplet therapy-integrating ADT, docetaxel, and an ARSI-has emerged as an effective approach, particularly in high-volume metastatic disease, as supported by ARASENS and PEACE-1. Advances in imaging, such as PSMA PET-CT, have improved disease detection, allowing earlier detection of metastasis and appropriate therapy. Similarly, genomic profiling has enabled biomarker-driven, personalized treatment strategies. The role of treatment of the primary tumor, by either radiation therapy or cytoreductive prostatectomy, in low-volume disease continues to be explored. As novel therapies, targeted agents, and immunotherapies undergo investigation, optimizing treatment selection based on disease burden, molecular characteristics, and patient factors will be essential. The future of mHSPCa management lies in multidisciplinary, precision-based approaches to improve patient outcomes while balancing treatment efficacy and tolerability.
转移性激素敏感性前列腺癌（mHSPCa）可初发出现，或代表显著的疾病进展，需要进行全身治疗。然而，进展为去势抵抗是不可避免的。随着强化全身治疗的引入，治疗格局不断演变，强化全身治疗包括雄激素剥夺治疗（ADT）联合雄激素受体信号抑制剂（ARSIs）或细胞毒性化疗（双联疗法），或两种药物联合治疗（三联疗法）。CHAARTED、STAMPEDE、LATITUDE、ENZAMET和TITAN等具有里程碑意义的试验已将联合治疗确立为标准治疗方案，显示出显著的总生存获益。最近，整合ADT、多西他赛和ARSIs的三联疗法已成为一种有效的治疗方法，尤其是在高负荷转移性疾病中，ARASENS和PEACE-1研究提供了支持。成像技术的进步，如PSMA PET-CT，改善了疾病检测，能够更早地发现转移并进行适当治疗。同样，基因组分析促成了基于生物标志物的个性化治疗策略。对于低负荷疾病，通过放射治疗或减瘤性前列腺切除术治疗原发肿瘤的作用仍在探索中。随着新型疗法、靶向药物和免疫疗法的研究不断推进，根据疾病负担、分子特征和患者因素优化治疗选择至关重要。mHSPCa管理的未来在于采用多学科、基于精准医学的方法，在平衡治疗疗效和耐受性的同时改善患者预后。
