背景:主动监测(AS)是低风险和选定中危前列腺癌(PCa)患者的标准护理。然而,缺乏关于AS期间如何影响疾病轨迹的总结证据。
目的:评估在AS期间哪些干预措施能有效预防PCa进展。
方法:我们查询PubMed,Scopus,和WebofScience数据库来确定研究旨在减缓AS期间疾病进展的干预措施的影响。主要终点是PCa进展,其定义必须包括病态升级。次要终点包括治疗毒性。
结果:我们确定了22项研究,6项随机对照试验和16项观察性研究,分析了不同干预措施与AS期间PCa进展之间的关系。研究中考虑的干预措施包括5-α还原酶抑制剂(5-ARIs),他汀类药物,饮食,锻炼,氯丁酮,非索波肽三氟(FT),恩扎鲁他胺,咖啡,维生素D3和PROSTVAC。我们发现给予5-ARIs与无进展生存期改善相关(PFS;风险比:0.59;95%置信区间0.48-0.72),没有增加的毒性信号。治疗如维生素D3,氯丁酮,FT,恩杂鲁胺也显示出一定的疗效。然而,在高达88%的患者中,这些抗癌药物与治疗相关的不良事件相关.
结论:在PCaAS患者中使用5-ARIs与较长的PFS相关。然而,对于其他干预措施,很难根据现有的薄弱证据得出明确的结论。
结果:接受5-α还原酶抑制剂治疗的主动监测(AS)前列腺癌患者的疾病进展风险较低,最小的不良事件。其他干预措施需要更多的研究来确定其在男性AS患者中的疗效和安全性。
BACKGROUND: Active surveillance (AS) is a standard of care for patients with low-risk and selected intermediate-risk prostate cancer (PCa). Nevertheless, there is a lack of summary evidence on how to impact disease trajectory during AS.
OBJECTIVE: To assess which interventions prevent PCa progression effectively during AS.
METHODS: We queried PubMed, Scopus, and Web of Science databases to identify studies examining the impact of interventions aimed at slowing disease progression during AS. The primary endpoint was PCa progression, the definition of which must have included pathological upgrading. The secondary endpoint included treatment toxicities.
RESULTS: We identified 22 studies, six randomized controlled trials and 16 observational studies, which analyzed the association between different interventions and PCa progression during AS. The interventions considered in the studies included 5-alpha reductase inhibitors (5-ARIs), statins, diet, exercise, chlormadinone, fexapotide triflutate (FT), enzalutamide, coffee, vitamin D3, and PROSTVAC. We found that administration of 5-ARIs was associated with improved progression-free survival (PFS; hazard ratio: 0.59; 95% confidence interval 0.48-0.72), with no increased toxicity signals. Therapies such as vitamin D3, chlormadinone, FT, and enzalutamide have shown some efficacy. However, these anticancer drugs have been associated with treatment-related adverse events in up to 88% of patients.
CONCLUSIONS: The use of 5-ARIs in PCa patients on AS is associated with longer PFS. However, for the other interventions, it is difficult to draw clear conclusions based on the weak available evidence.
RESULTS: Patients with prostate cancer managed with active surveillance (AS) who are treated with 5-alpha reductase inhibitors have a lower risk of disease progression, with minimal adverse events. Other interventions require more studies to determine their efficacy and safety profile in men on AS.