文章：

临床局限性前列腺癌根治性前列腺切除术前的治疗强化

Treatment Intensification Prior to Radical Prostatectomy for Clinically Localized Prostate Cancer

原文发布日期：7 July 2025

DOI: 10.3390/cancers17132258

类型: Article

开放获取: 是

英文摘要：

Current guidelines recommend either radical prostatectomy (RP) or radiation with androgen deprivation therapy (ADT) for unfavorable intermediate- or high-risk prostate cancer. There has been emerging interest in the potential benefits of neoadjuvant ADT prior to RP for this population. Past trials indicate neoadjuvant ADT may be associated with reduced surgical complexity, pathologic downstaging, decreased positive margins, and decreased rates of nodal positivity, although they have not shown benefits for cancer progression and survival. Accordingly, neoadjuvant ADT is currently not recommended for surgical patients. Conversely, ADT is a mainstay of treatment in metastatic disease, and interest remains in expanding its use towards patients with clinically localized disease. There are several ongoing trials of second-generation androgen blockers such as enzalutamide, darolutamide, radiopharmaceuticals, and poly (ADP-ribose) polymerase (PARP) inhibitors to explore long-term cancer-specific survival benefits with neoadjuvant use. In this narrative review, we provide a comprehensive overview of the recent literature and ongoing efforts to incorporate neoadjuvant therapy for clinically localized prostate cancer patients who are at high-risk of recurrence after prostatectomy.

摘要翻译： 

当前指南建议对预后不良的中危或高危前列腺癌患者采用根治性前列腺切除术（RP）或联合雄激素剥夺疗法（ADT）的放射治疗。近年来，针对该人群在RP前使用新辅助ADT的潜在获益逐渐受到关注。既往试验表明，新辅助ADT可能有助于降低手术复杂性、实现病理降期、减少切缘阳性率及淋巴结阳性率，但尚未显示其在癌症进展和生存率方面的获益。因此，目前不推荐手术患者常规使用新辅助ADT。相反，ADT是转移性疾病的主要治疗手段，其在临床局限性前列腺癌患者中的应用拓展仍受关注。目前多项试验正在研究第二代雄激素阻断剂（如恩杂鲁胺、达洛鲁胺）、放射性药物以及聚腺苷二磷酸核糖聚合酶（PARP）抑制剂等新辅助治疗的长期癌症特异性生存获益。本文通过叙述性综述，系统回顾近期文献及当前探索方向，重点关注如何将新辅助治疗整合应用于前列腺切除术后高复发风险的临床局限性前列腺癌患者。

原文链接：

Treatment Intensification Prior to Radical Prostatectomy for Clinically Localized Prostate Cancer