Selective treatment de-escalation in advanced prostate cancer: have we come full circle?

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2025-01-02 DOI:10.1111/bju.16632

Bryan Chong, Marniza Saad, Tsung Wen Chong, John Thng, Yu Guang Tan, Kae Jack Tay, Christopher Cheng, Po-Hung Lin, Jeremy Teoh, Peter Ka-Fung Chiu, Nathan Lawrentschuk, Renu Eapen, Declan Murphy, Johan Chan, Melvin L.K. Chua, Jeffrey Tuan, John Yuen, Ravindran Kanesvaran, Kenneth Chen

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Abstract

Compelling evidence has solidified the notion of early treatment intensification in managing patients with metastatic hormone-sensitive prostate cancer (mHSPC). Landmark trials have provided Level 1 evidence for the survival benefits achieved by combining multiple agents. The efficacy of combined therapy relies not only on how treatment is intensified but also on how it is de-escalated. This underscores the importance of tailored treatment approaches, potentially involving a reduction in therapy for specific patients, to strike a balance between the benefits of hormonal treatment and its associated adverse effects. While de-escalation of therapy in mHSPC remains challenging due to limited evidence, it is recommended for elderly or frail patients, those with poor performance status, or experiencing significant toxicity. However, for patients with excellent prostate-specific antigen responses or favourable biomarkers, decisions should be personalised, weighing the potential benefits of continued treatment against the risk of long-term side effects, using risk stratification tools where appropriate.

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晚期前列腺癌的选择性降级治疗：我们是否已经走过了一个完整的轮回？

令人信服的证据已经巩固了早期治疗强化管理转移性激素敏感前列腺癌（mHSPC）患者的概念。具有里程碑意义的试验提供了1级证据，证明联合使用多种药物可获得生存益处。联合治疗的疗效不仅取决于如何加强治疗，还取决于如何减少治疗。这强调了量身定制治疗方法的重要性，可能涉及减少对特定患者的治疗，以在激素治疗的益处及其相关副作用之间取得平衡。尽管由于证据有限，mHSPC的降压治疗仍然具有挑战性，但推荐用于老年或体弱患者、表现不佳或经历显著毒性的患者。然而，对于具有出色的前列腺特异性抗原反应或有利的生物标志物的患者，应根据个人情况做出决定，权衡继续治疗的潜在益处和长期副作用的风险，并在适当的情况下使用风险分层工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.