The contemporary treatment for metastatic castration-sensitive prostate cancer (mCSPC) has evolved significantly, building on successes in managing metastatic castration-resistant prostate cancer (mCRPC). Although androgen deprivation therapy (ADT) alone has long been the cornerstone of mCSPC treatment, combination therapies have emerged as the new standard of care based on recent advances, offering improved survival outcomes. Landmark phase 3 trials demonstrated that adding chemotherapy (docetaxel) and androgen receptor pathway inhibitors to ADT significantly enhances overall survival, particularly for patients with high-volume, high-risk, or de novo metastatic disease. Despite these advancements, a concerning gap between evidence-based guidelines and real-world practice remains, with many patients not receiving recommended combination therapies. The challenge in optimizing therapy sequences, considering both disease control and treatment burdens, and identifying clinical and biological subgroups that could benefit from personalized treatment strategies persists. The advent of triplet therapy has shown promise in extending survival, but the uro-oncology community must narrow the gap between evidence and practice to deliver the most effective care. Current research is focused on refining treatment approaches and utilizing biomarkers to guide therapy selection, aiming to offer more personalized and adaptive strategies for mCSPC management. Thus, aligning clinical practices with the evolving evidence is urgently needed to improve outcomes for patients facing this incurable disease.
转移性激素敏感性前列腺癌（mCSPC）的当代治疗策略已取得显著进展，其发展建立在转移性去势抵抗性前列腺癌（mCRPC）治疗成功经验的基础之上。虽然单纯雄激素剥夺疗法（ADT）长期以来一直是mCSPC治疗的基石，但基于近年来的研究突破，联合治疗方案已成为新的标准治疗模式，显著改善了患者的生存预后。具有里程碑意义的三期临床试验证实，在ADT基础上联合化疗（多西他赛）或雄激素受体通路抑制剂能显著提高总生存期，尤其对高肿瘤负荷、高危或初诊转移性患者效果更为明显。尽管取得这些进展，循证指南与临床实践之间仍存在显著差距，许多患者未能接受推荐的联合治疗方案。在优化治疗序列时，如何平衡疾病控制与治疗负担，以及识别可能从个体化治疗策略中获益的临床和生物学亚组，仍是当前面临的挑战。三联疗法的出现为延长生存期带来新希望，但泌尿肿瘤学界必须缩小证据与实践之间的差距，以提供最有效的治疗方案。当前研究重点在于完善治疗策略，利用生物标志物指导治疗选择，旨在为mCSPC管理提供更个体化、适应性的治疗方案。因此，亟需推动临床实践与不断发展的循证证据保持一致，从而改善这一不可治愈疾病患者的临床结局。
肿瘤(癌症)患者之家