PDF(Pubmed)
Abstract：
UNASSIGNED: Metastatic hormone-sensitive prostate cancer (mHSPC) displays both simultaneous and sequential patterns of metastasis, emphasizing a comprehensive treatment approach that integrates both local therapy and systemic treatment strategies. The increasing use of molecular imaging has led to a rise in mHSPC diagnoses, underscoring the importance of identifying the right patient population and effective treatment concepts for this disease state.
UNASSIGNED: Two prospective trials, HORRAD and STAMP EDE, investigated prostate radiotherapy (RT) for mHSPC; however, they did not show an overall survival (OS) benefit in the unselected cohort. Nonetheless, RT showed favorable outcomes in patients with fewer than five bone metastases, resulting in a 7% 3-year survival improvement and supporting the integration of RT in multimodal treatment for men with oligometastatic mHSPC. Regarding cytoreductive prostatectomy (cRP), the TRoMbone Trial confirmed its feasibility and safety. In addition, findings from the FUSCC-OMPCa Trial demonstrated improved 3-year radiographic progression-free survival and OS rates with acceptable rates of complications and incontinence. Recent data from the LoMP registry have further supported superior OS and cancer-specific survival (CSS) in patients undergoing cRP compared to systemic therapy alone. Notably, no significant differences in OS and CSS were observed between the cRP and RT groups. However, cRP-treated patients exhibited superior 2-year local event-free survival when compared to those treated with RT.
UNASSIGNED: RT in combination with systemic therapy remains the established first-line treatment for low-burden mHSPC, though the exact definition of low metastatic burden remains contentious. Precise assessment of metastatic burden is vital to identify patients who would derive the greatest benefit from RT. As treatment paradigms evolve, embracing multimodal approaches holds potential for optimizing outcomes in patients with mHSPC. Further research is needed to solidify the role of cRP as a standard therapeutic approach and to refine treatment strategies for improved patient outcomes.
UNASSIGNED: Two prospective trials, HORRAD and STAMP EDE, investigated prostate radiotherapy (RT) for mHSPC; however, they did not show an overall survival (OS) benefit in the unselected cohort. Nonetheless, RT showed favorable outcomes in patients with fewer than five bone metastases, resulting in a 7% 3-year survival improvement and supporting the integration of RT in multimodal treatment for men with oligometastatic mHSPC. Regarding cytoreductive prostatectomy (cRP), the TRoMbone Trial confirmed its feasibility and safety. In addition, findings from the FUSCC-OMPCa Trial demonstrated improved 3-year radiographic progression-free survival and OS rates with acceptable rates of complications and incontinence. Recent data from the LoMP registry have further supported superior OS and cancer-specific survival (CSS) in patients undergoing cRP compared to systemic therapy alone. Notably, no significant differences in OS and CSS were observed between the cRP and RT groups. However, cRP-treated patients exhibited superior 2-year local event-free survival when compared to those treated with RT.
UNASSIGNED: RT in combination with systemic therapy remains the established first-line treatment for low-burden mHSPC, though the exact definition of low metastatic burden remains contentious. Precise assessment of metastatic burden is vital to identify patients who would derive the greatest benefit from RT. As treatment paradigms evolve, embracing multimodal approaches holds potential for optimizing outcomes in patients with mHSPC. Further research is needed to solidify the role of cRP as a standard therapeutic approach and to refine treatment strategies for improved patient outcomes.
摘要：
■转移性激素敏感型前列腺癌（mHSPC）表现出同时和连续的转移模式，强调综合治疗方法，整合局部治疗和系统治疗策略。越来越多的分子成像的使用导致了mHSPC诊断的增加，强调为这种疾病状态确定正确的患者群体和有效的治疗理念的重要性。
■两项前瞻性试验，马拉德和印记EDE，研究了mHSPC的前列腺放射治疗（RT）；然而，他们在未选择的队列中未显示总生存期(OS)获益.尽管如此，RT在骨转移少于5例的患者中显示出良好的预后，导致7％的3年生存率提高，并支持将RT整合到多模式治疗中，用于低聚mHSPC的男性。关于细胞减灭术（cRP），TRoMbone试验证实了其可行性和安全性.此外,FUSCC-OMPCa试验的结果显示,3年放射学无进展生存率和OS率提高,并发症和失禁发生率可接受.LoMP注册的最新数据进一步支持了与单独的全身治疗相比，接受cRP的患者具有更高的OS和癌症特异性生存率（CSS）。值得注意的是,cRP组和RT组之间OS和CSS无显著差异。然而,与接受RT治疗的患者相比，接受cRP治疗的患者具有较高的2年无局部事件生存率。
■RT结合全身治疗仍然是低负担mHSPC的既定一线治疗方法，尽管低转移负担的确切定义仍存在争议。精确评估转移负担对于确定将从RT中获得最大益处的患者至关重要。随着治疗范式的发展，采用多模式方法有可能优化mHSPC患者的结局.需要进一步的研究来巩固cRP作为标准治疗方法的作用，并完善治疗策略以改善患者的预后。
■两项前瞻性试验，马拉德和印记EDE，研究了mHSPC的前列腺放射治疗（RT）；然而，他们在未选择的队列中未显示总生存期(OS)获益.尽管如此，RT在骨转移少于5例的患者中显示出良好的预后，导致7％的3年生存率提高，并支持将RT整合到多模式治疗中，用于低聚mHSPC的男性。关于细胞减灭术（cRP），TRoMbone试验证实了其可行性和安全性.此外,FUSCC-OMPCa试验的结果显示,3年放射学无进展生存率和OS率提高,并发症和失禁发生率可接受.LoMP注册的最新数据进一步支持了与单独的全身治疗相比，接受cRP的患者具有更高的OS和癌症特异性生存率（CSS）。值得注意的是,cRP组和RT组之间OS和CSS无显著差异。然而,与接受RT治疗的患者相比，接受cRP治疗的患者具有较高的2年无局部事件生存率。
■RT结合全身治疗仍然是低负担mHSPC的既定一线治疗方法，尽管低转移负担的确切定义仍存在争议。精确评估转移负担对于确定将从RT中获得最大益处的患者至关重要。随着治疗范式的发展，采用多模式方法有可能优化mHSPC患者的结局.需要进一步的研究来巩固cRP作为标准治疗方法的作用，并完善治疗策略以改善患者的预后。
