The role of androgen deprivation therapy prior to radical prostatectomy in high-risk prostate cancer: a systematic review.

IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Yenny Arroyo-Rojas, Lara Rodriguez-Sanchez, Gianmarco Colandrea, Hugo Otaola Arca, Camille Lanz, Eric Barret, Rafael Sanchez-Salas, Petr Macek, Xavier Cathelineau
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Abstract

Introduction: Patients with high-risk prostate cancer (HRPCa) are prone to have worse pathological features, resulting in early biochemical recurrence after radical prostatectomy (RP). There is an urgent need to develop novel treatment strategies for this group of patients to optimize their outcomes. The purpose of this study is to perform a systematic review of the role of neoadjuvant hormonal therapy (NHT) followed by RP in HRPCa patients.

Evidence acquisition: We performed a systematic review of the following databases, MEDLINE (PubMed), EMBASE, Cochrane Library, and clinical Trial.gov; between January 2007 and August 2023, following the PRISMA guidelines.

Evidence synthesis: After screening and deduplication, we included ten studies from an initial pool of 1275. The risk of bias was low in observational studies but ranged from moderate to low in controlled trials. Five studies utilized traditional androgen deprivation treatments (ADT), revealing favorable pathological outcomes but inconsistency in evaluating oncological results. Additionally, four studies focused on RP combined with androgen receptor pathway inhibitors (ARPIs) in the NHT setting, all showing primarily positive pathological outcome, with no clear evidence of an oncological benefit. Limited long-term follow-up data and a shortage of randomized controlled trials were evident among all the studies included in this review, regardless of the type of hormonal treatment used.

Conclusions: Different hormonal treatments, including traditional ADT and ARPIs, yield positive pathology outcomes. Oncological evidence remains limited, echoing older findings predating ARPIs. Definitive conclusions require longer follow-ups and precise patient selection. Currently, insufficient evidence support ARPIs' superiority over conventional therapy before RP.

前列腺癌根治术前雄激素剥夺疗法在高危前列腺癌中的作用:系统综述。
简介高危前列腺癌(HRPCa)患者的病理特征容易恶化,导致根治性前列腺切除术(RP)后的早期生化复发。目前迫切需要为这类患者开发新的治疗策略,以优化他们的治疗效果。本研究的目的是对新辅助激素疗法(NHT)和前列腺癌根治术在HRPCa患者中的作用进行系统回顾:我们按照 PRISMA 指南,对 2007 年 1 月至 2023 年 8 月期间的下列数据库进行了系统综述:MEDLINE (PubMed)、EMBASE、Cochrane Library 和 clinical Trial.gov:经过筛选和删减,我们从最初的 1275 项研究中纳入了 10 项研究。观察性研究的偏倚风险较低,而对照试验的偏倚风险从中度到低度不等。五项研究采用了传统的雄激素剥夺疗法(ADT),显示出良好的病理结果,但对肿瘤结果的评估并不一致。此外,有四项研究关注了在 NHT 环境下 RP 与雄激素受体通路抑制剂(ARPIs)的联合应用,所有研究均显示出积极的病理结果,但没有明确的证据表明其具有肿瘤学益处。无论采用哪种激素治疗方法,本综述所纳入的所有研究都存在长期随访数据有限和随机对照试验不足的问题:结论:不同的激素治疗,包括传统的 ADT 和 ARPIs,都能产生积极的病理结果。肿瘤学证据仍然有限,与 ARPIs 之前的研究结果一致。明确的结论需要更长时间的随访和精确的患者选择。目前,还没有足够的证据支持 ARPIs 在 RP 前优于传统疗法。
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来源期刊
Minerva Urology and Nephrology
Minerva Urology and Nephrology UROLOGY & NEPHROLOGY-
CiteScore
8.50
自引率
32.70%
发文量
237
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