文章：

前列腺癌新辅助疗法——当前范式与未来方向

Neoadjuvant Therapies for Prostate Cancer–Current Paradigms and Future Directions

原文发布日期：24 December 2025

DOI: 10.3390/cancers18010065

类型: Article

开放获取: 是

英文摘要：

High-risk and locally advanced prostate cancer represents 20–25% of new diagnoses of prostate cancer and is associated with high rates of recurrence, morbidity, and mortality. The neoadjuvant window provides a unique opportunity for systemic control prior to definitive therapy with radical prostatectomy or radiotherapy (RT). Early trials with first-generation androgen deprivation therapy (ADT) achieved pathological downstaging but no survival benefit. In the 2000s, the advent of chemohormonal regimes using docetaxel provided excitement but mixed results tempered expectations and is now not recommended prior to surgery. Second-generation androgen receptor pathway inhibitors (ARPIs) combined with ADT have demonstrated significant survival benefit in metastatic prostate cancer and are currently being evaluated in large phase III trials in the neoadjuvant setting. RT remains an alternative curative modality, and recent data highlights similar issues to surgery in eradicating micrometastatic disease despite excellent local control. This has driven parallel efforts to evaluate intensified systemic therapy in the pre-RT/neoadjuvant settings. In addition to the excitement surrounding ARPIs, radioligand therapy, such as [177Lu]Lu-PSMA-617 has shown promise in the neoadjuvant setting and continues to be investigated. Future research aims to incorporate genomic and molecular factors to enable personalised neoadjuvant therapies by identifying damage immunologically responsive subtypes that may derive greater benefit from immune-directed therapies in the peri-operative setting. This narrative review synthesises current evidence for neoadjuvant therapies in high-risk prostate cancer and future directions.

摘要翻译： 

高危和局部进展性前列腺癌占新诊断前列腺癌的20%-25%，其复发率、并发症发生率和死亡率均较高。新辅助治疗窗口期为根治性前列腺切除术或放疗（RT）前的系统性控制提供了独特机遇。早期采用第一代雄激素剥夺疗法（ADT）的试验实现了病理降期，但未带来生存获益。21世纪初，多西他赛化疗联合内分泌治疗方案的出现曾引发关注，但疗效不一的结果降低了预期，目前不推荐在手术前使用。第二代雄激素受体通路抑制剂（ARPIs）联合ADT在转移性前列腺癌中已显示出显著的生存获益，目前正在新辅助治疗背景下开展大型III期临床试验评估。放疗仍是替代性根治手段，最新数据显示尽管局部控制效果良好，但在清除微转移病灶方面仍存在与手术类似的局限性。这推动了对放疗前/新辅助阶段强化系统治疗的平行研究。除ARPIs带来的突破外，放射性配体疗法（如[¹⁷⁷Lu]Lu-PSMA-617）在新辅助治疗中展现出潜力并持续探索中。未来研究将整合基因组学与分子特征，通过识别免疫应答敏感亚型，为围手术期免疫靶向治疗获益人群提供个性化新辅助治疗方案。本文综述了高危前列腺癌新辅助治疗的现有证据及未来发展方向。

原文链接：

Neoadjuvant Therapies for Prostate Cancer–Current Paradigms and Future Directions