Adefehinti Mayowa, George Althea O, Enemoh Obinna, Adenipekun Blessing, Akinwale Mobolaji, Akintayo Abiodun, Sanni Quadri A, Adebisi Ajibola A, Erewele Ehizokhae, Onipede Oluwabukunmi, Oore-Ofe Ojeyemi, Ibikunle Toluwanimi P, Ajani Opemipo O
Urology, Peterborough City Hospital, Peterborough, GBR.
Urology, The Royal London Hospital, London, GBR.
Cureus. 2025 Aug 12;17(8):e89863. doi: 10.7759/cureus.89863. eCollection 2025 Aug.
Locally advanced prostate cancers (LAPC) are a clinical dilemma due to their biological heterogeneity and multiple algorithmic treatment options. Recent years have seen a great deal of progress in management, both in established methods and new modalities. This had led to a necessity to systematically map out existing evidence. This scoping review intends to systematically integrate and summarize the zeitgeist research in the area of the care of LAPC to advance the available knowledge, discuss emergent management strategies, and identify evidence needs in different healthcare settings. A scoping review was undertaken following the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A primary study search was conducted on six electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL Plus, and Cochrane Library) and gray literature sources published between 2013 and April 2025. The Population-Concept-Context (PCC) framework guided the eligibility. Data were plotted and thematically synthesized into six key domains: hormonal therapy, radiotherapy innovations, surgical strategies, new systemic therapies, imaging improvements, and real-life evidence. Six studies were included, consisting of a randomized controlled trial, an observational study, and a diagnostic review. The main themes were the benefits of multimodal treatment, the impact of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging and genomic profiling, and the role of second-generation androgen receptor inhibitors and regional disparities in access to treatments. Combination therapies showed oncologic benefits, but raised concerns about patients' quality-of-life outcomes. The management of LAPC is moving to a related precision-based, multimodal paradigm. Although current knowledge supports more aggressive and individualized therapy, there are still data gaps in long-term outcomes, global uptake, and patient-reported measures. Future research needs to be based on inclusive longitudinal studies that span between clinical innovation and real-world application.
局部晚期前列腺癌（LAPC）因其生物学异质性和多种算法治疗方案而成为临床难题。近年来，无论是既定方法还是新的治疗方式，在管理方面都取得了很大进展。这就需要系统地梳理现有证据。本范围综述旨在系统整合和总结LAPC护理领域的时代精神研究，以推进现有知识，讨论新出现的管理策略，并确定不同医疗环境中的证据需求。按照乔安娜·布里格斯研究所的方法进行了范围综述，并按照系统评价和Meta分析扩展的范围综述（PRISMA-ScR）指南进行报告。在六个电子数据库（MEDLINE、Embase、Scopus、Web of Science、CINAHL Plus和Cochrane图书馆）以及2013年至2025年4月期间发表的灰色文献来源上进行了主要研究搜索。人口-概念-背景（PCC）框架指导了纳入标准。数据被绘制出来并进行主题综合，形成六个关键领域：激素治疗、放疗创新、手术策略、新的全身治疗、影像改善和真实世界证据。纳入了六项研究，包括一项随机对照试验、一项观察性研究和一项诊断综述。主要主题包括多模式治疗的益处、前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）成像和基因组分析的影响、第二代雄激素受体抑制剂的作用以及治疗可及性方面的地区差异。联合疗法显示出肿瘤学益处，但引发了对患者生活质量结果的担忧。LAPC的管理正在转向基于相关精准的多模式范式。尽管目前的知识支持更积极和个性化的治疗，但在长期结果、全球应用和患者报告的指标方面仍存在数据空白。未来的研究需要基于涵盖临床创新和实际应用的包容性纵向研究。
