Suzuki Kotaro, Fujimoto Naohiro, Shiota Masaki, Kawakami Satoru, Kimura Takahiro, Hashimoto Kohei, Kosaka Takeo, Miyake Hideaki, Uemura Hiroji
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Jpn J Radiol. 2025 Jun 18. doi: 10.1007/s11604-025-01816-3.
With the advent of androgen receptor signaling inhibitors (ARSI), chemotherapy, poly (adenosine diphosphate-ribose) polymerase inhibitor (PARPi), and radioligand therapy targeting prostate-specific membrane antigen (PSMA), survival outcomes in metastatic prostate cancer (PCa) have dramatically improved over the past two decades. In addition, recent advancements in imaging modalities and genomic testing have significantly impacted diagnostic and therapeutic strategies for advanced PCa. However, with increasing drug options and the emergence of new disease concepts for non-metastatic castration-resistant prostate cancer (nmCRPC), treatment strategies for advanced PCa have become more complicated and uncertain. In addition, the emergence of aggressive PCa variants, including treatment-related neuroendocrine PCa (t-NEPC), is another clinical concern in the era of upfront and long-term use of potent ARSIs. The aim of this review is to summarize the latest drug treatment strategies and clinical concerns in the management of advanced PCa in Japan, based on the Japanese Clinical Practice Guidelines for Prostate Cancer published in 2023.
随着雄激素受体信号抑制剂（ARSI）、化疗、聚（腺苷二磷酸核糖）聚合酶抑制剂（PARPi）以及靶向前列腺特异性膜抗原（PSMA）的放射性配体疗法的出现，在过去二十年中，转移性前列腺癌（PCa）的生存结果有了显著改善。此外，成像模式和基因检测的最新进展对晚期PCa的诊断和治疗策略产生了重大影响。然而，随着药物选择的增加以及非转移性去势抵抗性前列腺癌（nmCRPC）新疾病概念的出现，晚期PCa的治疗策略变得更加复杂和不确定。此外，侵袭性PCa变体的出现，包括与治疗相关的神经内分泌PCa（t-NEPC），是在早期和长期使用强效ARSI时代的另一个临床关注点。本综述的目的是根据2023年发布的日本前列腺癌临床实践指南，总结日本晚期PCa管理中的最新药物治疗策略和临床关注点。
