文章：

非转移性激素敏感性前列腺癌局部根治性治疗后生化复发的早期与延迟雄激素剥夺疗法：文献系统综述

Early Versus Delayed Androgen Deprivation Therapy for Biochemical Recurrence After Local Curative Treatment in Non-Metastatic Hormone-Sensitive Prostate Cancer: A Systematic Review of the Literature

原文发布日期：10 January 2025

DOI: 10.3390/cancers17020215

类型: Article

开放获取: 是

英文摘要：

Background: The ideal timing of androgen deprivation therapy (ADT) for patients with biochemical recurrence (BCR) of prostate cancer (PCa) remains controversial due to its side effects and uncertain impact on survival outcomes. Methods: We performed a review of the current literature by comprehensively searching the PubMed, Embase, and Cochrane databases to determine the optimal timing of ADT initiation after biochemical recurrence. We selected 26 studies including systematic reviews, randomized controlled trials (RCTs), and retrospective studies, while also reviewing practice guidelines. Results: Not all patients with BCR cancer experience clinical or radiological progression. While early ADT may delay progression, evidence of its effect on PCa-specific mortality remains inconclusive. The PSA thresholds for initiating ADT vary, complicating decision-making. Key predictors of progression include a short PSA doubling time (PSADT), a high Gleason score (GS), and a brief interval to BCR of PCa post-radiotherapy (RT). Combining ADT with androgen receptor pathway inhibitors (ARPIs) has been shown to improve metastasis-free survival in high-risk patients. Conclusion: The ideal timing of ADT initiation in BCR PCa remains uncertain. Early ADT can help control the progression, but its effect on PCa-specific mortality is unclear. Stratifying patients by their risk factors, such as their PSADT, GS, and time to BCR can guide individualized treatment. In high-risk patients, delaying ADT should be avoided, while combining ADT with an androgen receptor pathway inhibitor (ARPI) may further improve outcomes.

摘要翻译： 

背景：对于前列腺癌生化复发的患者，雄激素剥夺治疗的最佳时机因其副作用及对生存结局影响的不确定性而存在争议。方法：我们通过全面检索PubMed、Embase和Cochrane数据库，对现有文献进行综述，以确定生化复发后启动ADT的最佳时机。共纳入26项研究，包括系统综述、随机对照试验和回顾性研究，同时参考了临床实践指南。结果：并非所有生化复发患者均会出现临床或影像学进展。虽然早期ADT可能延缓疾病进展，但其对前列腺癌特异性死亡率的影响证据尚不明确。启动ADT的PSA阈值存在差异，这增加了临床决策的复杂性。疾病进展的关键预测因素包括较短的PSA倍增时间、较高的格里森评分以及放疗后至生化复发的间隔时间较短。研究表明，在高危患者中，ADT联合雄激素受体通路抑制剂可改善无转移生存期。结论：生化复发前列腺癌患者启动ADT的理想时机仍不确定。早期ADT有助于控制疾病进展，但其对前列腺癌特异性死亡率的影响尚不明确。根据PSA倍增时间、格里森评分和生化复发时间等风险因素对患者进行分层，可指导个体化治疗。高危患者应避免延迟ADT，而ADT联合雄激素受体通路抑制剂可能进一步改善临床结局。

原文链接：

Early Versus Delayed Androgen Deprivation Therapy for Biochemical Recurrence After Local Curative Treatment in Non-Metastatic Hormone-Sensitive Prostate Cancer: A Systematic Review of the Literature