The management of high-risk prostate cancer (PCa) presents a significant clinical challenge, often necessitating treatment intensification due to the potential presence of micrometastases. While radical prostatectomy (RP) constitutes one of the primary treatment modalities, the integration of neoadjuvant and adjuvant therapies suggests a paradigm shift towards more aggressive treatment strategies, also guided by new imaging modalities like positron emission tomography using prostate-specific membrane antigen (PSMA-PET). Despite the benefits, treatment intensification raises concerns regarding increased side effects. This review synthesizes the latest evidence on perioperative treatment intensification and de-escalation for high-risk localized and locally advanced PCa patients eligible for surgery. Through a non-systematic literature review conducted via PubMed, Scopus, Web of Science, and ClinicalTrials.gov, we explored various dimensions of perioperative treatments, including neoadjuvant systemic therapies, adjuvant therapies, and the role of novel diagnostic technologies. Emerging evidence provides more support for neoadjuvant systemic therapies. Preliminary results from studies suggest the potential for treatments traditionally reserved for metastatic PCa to show apparent benefit in a non-metastatic setting. The role of adjuvant treatments remains debated, particularly the use of androgen deprivation therapy (ADT) and adjuvant radiotherapy in patients at higher risk of biochemical recurrence. The potential role of radio-guided PSMA lymph node dissection emerges as a cutting-edge approach, offering a targeted method for eradicating disease with greater precision. Innovations such as artificial intelligence and machine learning are potential game-changers, offering new avenues for personalized treatment and improved prognostication. The intensification of surgical treatment in high-risk PCa patients is a dynamic and evolving field, underscored by the integration of traditional and novel therapeutic approaches. As evidence continues to emerge, these strategies will refine patient selection, enhance treatment efficacy, and mitigate the risk of progression, although with an attentive consideration of the associated side effects.
高危前列腺癌（PCa）的治疗是一项重大的临床挑战，由于可能存在微转移，通常需要强化治疗。虽然根治性前列腺切除术（RP）是主要的治疗方式之一，但新辅助治疗和辅助治疗的结合表明治疗策略正朝着更积极的方向转变，这也得益于前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）等新型影像技术的指导。尽管强化治疗具有益处，但也引发了人们对副作用增加的担忧。本综述综合了关于适合手术的高危局限性和局部晚期PCa患者围手术期强化和降级治疗的最新证据。通过PubMed、Scopus、Web of Science和ClinicalTrials.gov进行的非系统性文献回顾，我们探讨了围手术期治疗的多个方面，包括新辅助全身治疗、辅助治疗以及新型诊断技术的作用。新出现的证据为新辅助全身治疗提供了更多支持。初步研究结果表明，传统上用于转移性PCa的治疗在非转移性环境中可能显示出明显的益处。辅助治疗的作用仍存在争议，特别是对于生化复发风险较高的患者，雄激素剥夺疗法（ADT）和辅助放疗的使用。放射性引导的PSMA淋巴结清扫术作为一种前沿方法，其潜在作用日益凸显，为更精准地清除疾病提供了靶向手段。人工智能和机器学习等创新技术可能成为改变游戏规则的因素，为个性化治疗和改善预后提供了新途径。高危PCa患者手术治疗的强化是一个动态发展的领域，其核心在于传统与新型治疗方法的整合。随着证据的不断涌现，这些策略将优化患者选择、提高治疗效果并降低进展风险，尽管仍需密切关注相关副作用。
肿瘤(癌症)患者之家