De novo metastatic hormone-sensitive PC (mHSPC) accounts for 5–10% of all prostate cancer (PC) diagnoses but it is responsible for nearly 50% of PC-related deaths. Since 2015, the prognosis of mHSPC has slightly improved thanks to the introduction of new hormonal agents and chemotherapy combined with androgen deprivation therapy from the first-line setting. This review describes the current therapeutic opportunities for de novo mHSPC, focusing on potential molecular biomarkers identified in the main clinical trials that have modified the standard of care, the genomic features of de novo mHSPC, and the principal ongoing trials that are investigating new therapeutic approaches and the efficacy of a biomarker-guided treatment in this setting. The road toward personalized treatment for de novo mHSPC is still long, considering that the randomized clinical trials, which have furnished the basis of the current therapeutic options, stratified patients according to clinical criteria that did not necessarily reflect the biological rationale of the chosen therapy. The role of transcriptomic profiling of mHSPC as a predictive biomarker requires further validation, and it remains to be ascertained how the genomic variants detected in mHSPC, which are regarded as predictive in the castration-resistant disease, can be exploited in the mHSPC setting.
初诊转移性激素敏感性前列腺癌（mHSPC）占所有前列腺癌诊断的5-10%，却导致近50%的前列腺癌相关死亡。自2015年以来，随着新型激素药物及化疗联合雄激素剥夺疗法在一线治疗中的应用，mHSPC的预后得到一定改善。本综述系统阐述当前初诊mHSPC的治疗策略，重点分析以下三个维度：改变临床实践的主要临床试验中发现的潜在分子生物标志物、初诊mHSPC的基因组特征，以及正在探索新型治疗方法和生物标志物指导治疗疗效的核心临床试验。当前初诊mHSPC的个体化治疗之路仍任重道远，现有治疗方案的循证基础主要来自基于临床标准（未必反映治疗选择的生物学依据）进行患者分层的随机临床试验。mHSPC转录组图谱作为预测性生物标志物的价值尚需进一步验证，而mHSPC中检测到的基因组变异（在去势抵抗性疾病中已被证实具有预测价值）如何应用于mHSPC临床场景仍有待明确。
De Novo Metastatic Prostate Cancer: Are We Moving toward a Personalized Treatment?
肿瘤(癌症)患者之家