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Debate 3: Metastasis Directed Therapy in Oligometastatic Prostate Cancer 争论3：转移性前列腺癌的定向治疗

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.012

Maneesh Singh MD , Vedang Murthy MD , Piet Ost MD, PhD

Oligometastatic prostate cancer (OMPC), characterized by limited metastatic burden (≤5 lesions), encompasses 3 major subtypes: de novo synchronous oligometastatic hormone-sensitive prostate cancer (om-HSPC), metachronous oligorecurrent HSPC (or-HSPC), and oligoprogressive castrate-resistant prostate cancer (op-CRPC). Metastasis-directed therapy (MDT), particularly stereotactic body radiotherapy (SBRT), has been widely adopted and offers a noninvasive approach for delaying disease progression and achieving durable local control while maintaining the quality of life (QoL). This review examines the evolving evidence supporting MDT across OMPC spectrum. In de novo om-HSPC, early prospective studies suggest benefit when combining MDT with systemic therapy and local prostate radiation therapy (RT). However, conclusive randomized evidence for benefit of MDT in de-novo om-HSPC is lacking. For or-HSPC, randomized trials (STOMP, ORIOLE) demonstrate that SBRT-MDT safely delays systemic therapy initiation and prolongs progression-free survival (PFS). In nodal or-HSPC, the PEACE V-STORM trial has shown superior biochemical and locoregional control with elective nodal radiotherapy (ENRT) compared to SBRT alone. For well selected patients with OMPC, systemically augmented MDT (SBRT with short-course ADT±ARPI) is an attractive strategy to improve outcomes with no added QoL detriment and has shown more durable responses than either modality alone (EXTEND, RADIOSA trials). The recent WOLVERINE meta-analysis has shown that MDT improves PFS and overall survival across OMPC subtypes. Patient selection remains crucial, with PSA kinetics, PSMA-PET findings, and genomic factors emerging as potential biomarkers for personalizing the OMPC therapeutic landscape. While several phase III trials are ongoing, current evidence supports MDT integration into clinical practice for appropriately selected OMPC patients.

寡转移性前列腺癌（OMPC）以转移负担有限（≤5个病灶）为特征，包括3个主要亚型：新生同步寡转移性激素敏感前列腺癌（om-HSPC）、异时性寡复发性前列腺癌（or-HSPC）和寡进行性去势抵抗性前列腺癌（op-CRPC）。转移定向治疗（MDT），特别是立体定向体放疗（SBRT），已被广泛采用，并提供了一种非侵入性的方法来延缓疾病进展和实现持久的局部控制，同时保持生活质量（QoL）。本综述审查了支持跨OMPC谱MDT的不断发展的证据。在新发hspc中，早期前瞻性研究表明，MDT与全身治疗和局部前列腺放射治疗（RT）联合使用是有益的。然而，目前尚无确切的随机证据表明MDT对新生hspc患者有益。对于or-HSPC，随机试验（STOMP， ORIOLE）表明，SBRT-MDT安全地延迟了全身治疗的开始并延长了无进展生存期（PFS）。在淋巴结或hspc中，PEACE V-STORM试验显示，与单独SBRT相比，选择性淋巴结放疗（ENRT）具有更好的生化和局部控制。对于精心挑选的OMPC患者，系统增强MDT （SBRT +短期ADT±ARPI）是一种有吸引力的策略，可以改善结果，而不会增加生活质量损害，并且比单独使用任何一种方式（EXTEND， RADIOSA试验）显示出更持久的反应。最近的WOLVERINE荟萃分析表明，MDT改善了OMPC亚型的PFS和总生存率。患者选择仍然至关重要，PSA动力学、PSMA-PET结果和基因组因素正在成为个性化OMPC治疗前景的潜在生物标志物。虽然一些III期试验正在进行中，但目前的证据支持将MDT纳入适当选择的OMPC患者的临床实践。

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引用次数: 0

Debate 3: Oligometastatic Hormone Sensitive Prostate Cancer Management: Systemic Therapy Approach 辩论3：低转移性激素敏感性前列腺癌的管理：全身治疗方法

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.011

Gunhild von Amsberg MD , Moritz Kaune MD , Anja Coym MD , Nadja Strewinsky MD , Fabian Falkenbach MD , Jan Lukas Hohenhorst MD , Derya Tilki MD , Sergey Dyshlovoy PhD

Oligometastatic prostate cancer (OMPC) represents an intermediate stage between localized and extensive metastatic disease, characterized by a limited number of metastatic lesions. While metastasis-directed therapy (MDT) has gained traction for its potential to delay systemic therapy, systemic therapy itself is falling behind. In our view, this is not appropriate at the current stage. In the context of this controversy, we highlight the points that emphasize the role of systemic therapy in OMPC and point out weaknesses of data available on local treatment concepts. The lack of a standardized OMPC definition complicates the comparison of results across studies. Imaging inconsistencies, ranging from conventional techniques to advanced PSMA-PET/CT, further challenge accurate classification. Additionally, the biological basis of OMPC remains unclear, with no definitive biomarkers distinguishing it from polymetastatic disease. While MDT has demonstrated improved progression-free survival in small trials, its impact on overall survival remains inconclusive. Conversely, systemic therapy with androgen receptor pathway inhibitors (ARPIs) has shown a significant survival advantage in phase 3 trials. Subgroup analyses from large trials indicate a benefit of systemic therapy, particularly in low-volume disease. Combination strategies incorporating MDT and systemic therapy may optimize outcomes. Further research is needed to refine patient selection, integrate molecular biomarkers, and establish the optimal treatment paradigm. Until robust evidence emerges, systemic therapy remains the standard of care for OMPC.

少转移性前列腺癌（OMPC）是介于局部转移和广泛转移之间的中间阶段，其特征是转移灶数量有限。虽然转移导向疗法（MDT）因其延迟全身治疗的潜力而获得了关注，但全身治疗本身却落后了。我们认为，这在现阶段是不合适的。在这一争议的背景下，我们强调了强调全身治疗在OMPC中的作用的观点，并指出了有关局部治疗概念的现有数据的弱点。缺乏标准化的OMPC定义使跨研究结果的比较复杂化。从传统技术到先进的PSMA-PET/CT，成像不一致进一步挑战了准确的分类。此外，OMPC的生物学基础尚不清楚，没有明确的生物标志物将其与多转移性疾病区分开来。虽然MDT在小型试验中证明了无进展生存期的改善，但其对总生存期的影响仍不确定。相反，在3期试验中，雄激素受体途径抑制剂（arpi）的全身治疗显示出显着的生存优势。来自大型试验的亚组分析表明全身治疗的益处，特别是在小容量疾病中。结合MDT和全身治疗的联合策略可以优化结果。需要进一步的研究来完善患者选择，整合分子生物标志物，并建立最佳的治疗模式。在强有力的证据出现之前，全身治疗仍然是OMPC的标准治疗。

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引用次数: 0

Debate 1: Radical Prostatectomy For the Right Patient With High-Risk Prostate Cancer 辩论1：根治性前列腺切除术适合高危前列腺癌患者

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.05.001

Vinaik M. Sundaresan, Michael S. Leapman

Prostate cancer is a heterogeneous disease with varying degrees of metastatic potential and responsiveness to treatment. Whether surgical removal or radiation therapy combined with androgen deprivation therapy (ADT) is the best initial course of treatment for those with ‘high risk’ features poses an enduring clinical dilemma. In the absence of an adequate randomized clinical trial to resolve this question, contemporary decision-making seeks to balance expected treatment effectiveness and health-related quality of life over the long time horizon expected by most facing this choice. In this article, we distill the following 5 evidence-based arguments that commonly motivate patients to select radical prostatectomy as initial treatment of ‘high-risk’ prostate cancer. The first is that surgery alone provides excellent long-term cancer control and disease-related survival. Second, radical prostatectomy provides definitive local and regional disease staging, serving as the backbone for multimodality treatment if needed. Third, the sequencing of surgery before radiation is viewed as preferable beca by preserving options for effective local salvage. Fourth, initial surgery successfully defers or avoids the adverse effects of long-term androgen deprivation therapy in a substantial proportion of patients. Lastly, fifth, prostatectomy offers manageable impacts on urinary and sexual function, minimizing risk of gastrointestinal toxicity or secondary malignancy, and averts local symptomatic progression in most.

前列腺癌是一种异质性疾病，具有不同程度的转移潜力和对治疗的反应。对于那些具有“高风险”特征的患者来说，手术切除或放射治疗联合雄激素剥夺疗法（ADT）是最佳的初始治疗方案，这是一个持久的临床困境。在缺乏足够的随机临床试验来解决这个问题的情况下，当代的决策寻求平衡预期的治疗效果和与健康相关的生活质量，这是大多数面临这一选择的人所期望的。在本文中，我们总结了以下5个基于证据的论点，这些论点通常促使患者选择根治性前列腺切除术作为“高风险”前列腺癌的初始治疗。首先，单靠手术就能很好地长期控制癌症，提高与疾病相关的生存率。其次，根治性前列腺切除术提供了明确的局部和区域疾病分期，在必要时作为多模式治疗的支柱。第三，在放疗前进行手术排序被认为是可取的，因为这样可以保留有效的局部挽救的选择。第四，在相当比例的患者中，初始手术成功地延缓或避免了长期雄激素剥夺治疗的不良反应。最后，第五，前列腺切除术对泌尿和性功能的影响是可控的，将胃肠道毒性或继发性恶性肿瘤的风险降至最低，并避免大多数患者的局部症状进展。

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引用次数: 0

Radiopharmaceuticals in Prostate Cancer: General Considerations and Utility in Combination With EBRT 放射性药物治疗前列腺癌：与EBRT联合的一般考虑和效用

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.003

Caner Civan , Nika Guberina , Ulrich Krafft , Wolfgang P. Fendler , Martin Stuschke , Ken Herrmann

The management of prostate cancer has posed challenges for clinicians in determining optimal treatment strategies. Over the years, various radiopharmaceuticals have been utilized for both the diagnosis and treatment of the prostate cancer. Recent advancements in prostate specific membrane antigen (PSMA) based imaging have enabled the early and precise detection of local recurrence, lymph nodes or distant metastases, resulting a paradigm shift, which significantly influenced clinical decision making. Moreover, PSMA targeted treatments, as a part of theranostic approach, have introduced novel treatment options for patients with castration resistant metastatic prostate cancer, who were previously limited to palliative treatment alternatives. The clinical integration of PSMA based imaging and treatment has led to the commencement of collaborative studies across multiple disciplines including radiation oncology. Radiopharmaceuticals led by PSMA have the potential to facilitate accurate treatment decision making through earlier and more precise lesion detection, as well as improve patient outcomes when combined with radiotherapy. We aimed to review the role of radiopharmaceuticals in diagnosis and treatment of prostate cancer, focusing on their utility in guiding radiotherapy and the potential benefits of combining these radiopharmaceuticals with radiotherapy.

前列腺癌的治疗对临床医生提出了确定最佳治疗策略的挑战。多年来，各种放射性药物已被用于前列腺癌的诊断和治疗。基于前列腺特异性膜抗原（PSMA）成像技术的最新进展，使局部复发、淋巴结或远处转移的早期和精确检测成为可能，从而导致范式转变，这对临床决策产生了重大影响。此外，PSMA靶向治疗作为治疗方法的一部分，为去势抵抗性转移性前列腺癌患者提供了新的治疗选择，这些患者以前仅限于姑息治疗方案。基于PSMA的成像和治疗的临床整合导致了包括放射肿瘤学在内的多个学科的合作研究的开始。PSMA领导的放射性药物有可能通过更早、更精确的病变检测来促进准确的治疗决策，并在与放疗联合使用时改善患者的预后。本文旨在综述放射性药物在前列腺癌诊断和治疗中的作用，重点介绍放射性药物在指导放射治疗中的应用以及放射性药物与放射治疗联合使用的潜在益处。

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引用次数: 0

PSMA-PET Guided Radiotherapy in Prostate Cancer: A Critical Review of Current Applications and Future Directions PSMA-PET引导前列腺癌放射治疗：当前应用和未来方向的综述

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.05.004

Valentino Dragonetti , Marzia Colandrea , Laura Travaini , Lighea Simona Airò Farulla , Francesco Ceci , Francesco Mattana

Prostate-specific membrane antigen/positron emission tomography (PSMA-PET) changed the diagnostic approach in prostate cancer (PCa), providing superior diagnostic accuracy compared to conventional imaging (CI) modalities like computed tomography (CT), bone scintigraphy (BS) or other PET radiopharmaceuticals like choline or fluciclovine. This improved diagnostic accuracy plays a crucial role in its synergy with radiotherapy, particularly in the context of metastasis-directed therapy. Even in advanced stages of prostate cancer, the synergy with radiotherapy is evident in the promising results emerging from the combination of RT and RLT. To evaluate the value of PSMA as biomarker, the technological advancements in PSMA-PET, and its integration into clinical practice, focusing on its impact on RT and RLT. A comprehensive nonsystematic literature review was performed using PubMed/MEDLINE and EMBASE biomedical databases. Literature search was updated until March 2025. The most relevant studies have been summarized, giving priority to registered clinical trials and multicenter collaborations. The higher accuracy of PSMA-PET is advancing RT planning in PCa, from initial staging to salvage and metastasis-directed therapy. Ongoing trials combining RLT with external beam radiotherapy (EBRT) may expand its role into earlier stages. Key challenges include the need for long-term outcome data, standardization, cost-effectiveness, and avoiding overtreatment. Future efforts should optimize PSMA-guided RT, evaluate novel RLT combinations, and identify predictive biomarkers for personalized care. The synergy between PSMA-PET and radiotherapy enables a more effective therapeutic approach across both early and advanced stages of PCa, particularly through the promising integration with RLT.

前列腺特异性膜抗原/正电子发射断层扫描（PSMA-PET）改变了前列腺癌（PCa）的诊断方法，与传统成像（CI）方式(如计算机断层扫描（CT）、骨显像（BS）或其他PET放射性药物（如胆碱或氟氯叶碱）相比，它提供了更高的诊断准确性。这种改进的诊断准确性在其与放疗的协同作用中起着至关重要的作用，特别是在转移导向治疗的背景下。即使在前列腺癌晚期，放射治疗与放疗的协同作用也很明显，这是由RT和RLT联合出现的有希望的结果。评估PSMA作为生物标志物的价值，PSMA- pet的技术进步及其与临床实践的结合，重点关注其对RT和RLT的影响。使用PubMed/MEDLINE和EMBASE生物医学数据库进行全面的非系统文献综述。文献检索更新至2025年3月。总结了最相关的研究，优先考虑注册临床试验和多中心合作。PSMA-PET的更高准确性正在推进前列腺癌的RT计划，从初始分期到挽救和转移导向治疗。正在进行的RLT与外部放射治疗（EBRT）联合的试验可能会将其作用扩展到早期阶段。主要挑战包括需要长期结果数据、标准化、成本效益和避免过度治疗。未来的工作应优化psma引导的RT，评估新的RLT组合，并确定个性化护理的预测性生物标志物。PSMA-PET和放疗之间的协同作用使早期和晚期PCa的治疗方法更加有效，特别是通过与RLT的有希望的整合。

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引用次数: 0

Elective Regional Nodal Irradiation in Prostate Cancer 前列腺癌选择性局部淋巴结照射

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.010

Srinivas Chilukuri , Mutlay Sayan , Alan Dal Pra , Vedang Murthy

Elective nodal radiotherapy (ENRT) targets microscopic pelvic lymph node metastases to improve locoregional control in prostate cancer. Recent randomized trials report improved outcomes, particularly in high-risk cohorts, albeit with modest increases in Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities. Molecular imaging has markedly refined patient selection, enabling precise identification of occult nodal disease and enhancing application of ENRT beyond traditional clinical parameters. Modern radiation therapy approaches, including image-guided intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT), have enhanced ENRT efficacy and safety by employing stringent organ-at-risk constraints. Recent evidence supports SBRT-based ENRT (25 Gy in 5 fractions), demonstrating both efficacy and acceptable toxicity profiles. In the postoperative adjuvant context, ENRT shows promise for patients with pathological nodal involvement (pN+), particularly those with ≥3 positive nodes, high-grade disease, or positive surgical margins. In the salvage setting, combining ENRT with short-term androgen deprivation therapy (ADT) may benefit patients with biochemical recurrence and adverse pathological features, even in node-negative cases. Until definitive data emerges from ongoing randomized trials, multidisciplinary evaluation and integration of modern imaging and radiotherapy techniques remain essential for optimal ENRT in prostate cancer.

选择性淋巴结放疗（ENRT）靶向盆腔淋巴结转移以改善前列腺癌的局部控制。最近的随机试验报告了改善的结果，特别是在高风险队列中，尽管2级胃肠道（GI）和泌尿生殖系统（GU）毒性略有增加。分子成像显著改善了患者选择，能够精确识别隐匿性淋巴结疾病，并增强了ENRT在传统临床参数之外的应用。现代放射治疗方法，包括图像引导的调强放疗（IMRT）和立体定向体放疗（SBRT），通过采用严格的器官危险限制，提高了ENRT的疗效和安全性。最近的证据支持基于sbrt的ENRT(5份25 Gy)，显示出疗效和可接受的毒性特征。在术后辅助治疗方面，ENRT对病理性淋巴结受累（pN+）的患者，特别是那些≥3个阳性淋巴结、高度病变或手术切缘阳性的患者显示出希望。在挽救方面，ENRT联合短期雄激素剥夺治疗（ADT）可能有利于生化复发和不良病理特征的患者，即使是淋巴结阴性的病例。在正在进行的随机试验中获得明确的数据之前，多学科评估和现代成像和放疗技术的整合对于前列腺癌最佳ENRT仍然至关重要。

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引用次数: 0

Health Disparities and Inequities in Prostate Cancer Along the Continuum of Care 前列腺癌连续治疗过程中的健康差异和不公平

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.008

Ulysses Gardner , Allison B. Randolph , Nancy Anabaraonye , Cyrus Washington , Curtiland Deville Jr

Prostate cancer remains one of the most commonly diagnosed malignancies worldwide, yet significant disparities and inequities persist across the continuum of care. Black men face a disproportionate burden, exhibiting the highest incidence and mortality rates. Older patients often receive less aggressive treatment despite higher risk profiles. Insurance status critically influences timely diagnosis and treatment; uninsured and underinsured individuals are more likely to experience delays in care, leading to worse prognoses. Rural residents and those with lower-income have limited access to specialized care while those of lower education status have reduced screening and later-stage diagnoses. Disparities extend to biopsy techniques and treatment decisions. Black and other underserved populations are less likely to undergo targeted biopsies, which have been shown to improve tumor characterization and risk stratification. Additionally, they are more likely to receive non-definitive management, even when presenting with high-risk, potentially lethal disease. Socioeconomic barriers, healthcare access, provider biases, and underrepresentation and exclusion from clinical trials further exacerbate these disparities, limiting opportunities for precision medicine approaches tailored to diverse populations. Addressing these inequities requires a multifaceted approach, including increasing access to advanced diagnostics and therapeutics, improving representation in research, and integrating social determinants of health into prostate cancer management strategies. Emerging evidence on radiogenomics and molecular biomarkers offers promising avenues for personalized care, but equitable implementation is crucial to avoid widening existing gaps. A concerted effort to eliminate disparities is essential to achieving equitable prostate cancer outcomes across all populations.

前列腺癌仍然是世界上最常见的恶性肿瘤之一，但在整个治疗过程中仍然存在显著的差异和不平等。黑人男子面临着不成比例的负担，发病率和死亡率最高。老年患者通常接受较少的积极治疗，尽管风险较高。保险状况严重影响及时诊断和治疗；没有保险和保险不足的个人更有可能经历护理延误，导致更糟糕的预后。农村居民和低收入人群获得专业护理的机会有限，而受教育程度较低的人群则减少了筛查和后期诊断。差异延伸到活检技术和治疗决策。黑人和其他服务不足的人群不太可能接受有针对性的活组织检查，这已被证明可以改善肿瘤特征和风险分层。此外，他们更有可能接受不确定的治疗，即使出现高风险、潜在致命的疾病。社会经济障碍、医疗服务可及性、提供者偏见以及临床试验代表性不足和被排除等进一步加剧了这些差异，限制了针对不同人群量身定制的精准医疗方法的机会。解决这些不平等问题需要采取多方面的办法，包括增加获得先进诊断和治疗方法的机会，改善研究中的代表性，以及将健康的社会决定因素纳入前列腺癌管理战略。关于放射基因组学和分子生物标志物的新证据为个性化护理提供了有希望的途径，但公平实施对于避免扩大现有差距至关重要。齐心协力消除差异对于在所有人群中实现公平的前列腺癌结局至关重要。

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引用次数: 0

Debate 1: High-Risk Localized Prostate Cancer: Why Combination Hormone Therapy and Radiotherapy is the Optimal Treatment Strategy for Most Men 辩论1：高危局限性前列腺癌：为什么激素联合放疗是大多数男性的最佳治疗策略

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.05.003

Michael K. Rooney, Zakaria El Kouzi, Ramez Kouzy, Osama Mohamad, Karen E. Hoffman

Prostate cancer is the most commonly diagnosed malignancy among men in the United States, with high-risk localized disease accounting for approximately 15% of new cases. High-risk cancer portends increased risk of locoregional recurrence and distant metastases. Despite the longstanding use of radical prostatectomy (RP) and definitive radiotherapy (RT) with androgen deprivation therapy (ADT) as primary treatment options, there remains a lack of randomized data directly comparing these modalities. The ongoing SPCG-15 trial may eventually provide such evidence but its results are not expected until 2030. In the interim, clinicians must rely on existing observational studies to guide treatment selection. This review synthesizes current evidence comparing RP and RT+ADT for high-risk localized prostate cancer, highlighting oncologic outcomes, treatment-related toxicities, and patient-reported quality of life in survivorship. RT+ADT may offer biological advantages in addressing occult micrometastases with radiobiological foundations for synergy between modalities. Further, although observational data comparing RP and RT+ADT are heterogeneous and often methodologically limited, recent analyses using modern causal inference frameworks suggest improved distant metastatic control with RT+ADT. Toxicity profiles also differ significantly between modalities, with RT+ADT associated with fewer early and long-term urinary side effects, and less treatment regret but transient hormone-related and bowel symptoms during treatment. Here, we propose that under the shared-decision-making model RT+ADT will be the preferred first-line treatment for most men with high-risk localized prostate cancer, offering favorable oncologic control while preserving quality of life, particularly with modern advances in radiotherapy techniques.

前列腺癌是美国男性中最常见的恶性肿瘤，高风险的局部疾病约占新病例的15%。高风险癌症预示着局部复发和远处转移的风险增加。尽管长期使用根治性前列腺切除术（RP）和决定性放疗（RT）联合雄激素剥夺疗法（ADT）作为主要治疗选择，但仍然缺乏直接比较这些方式的随机数据。正在进行的spg -15试验可能最终会提供这样的证据，但其结果预计要到2030年才能出来。在此期间，临床医生必须依靠现有的观察性研究来指导治疗选择。本综述综合了目前比较RP和RT+ADT治疗高危局限性前列腺癌的证据，强调了肿瘤预后、治疗相关的毒性和患者报告的生存期生活质量。RT+ADT可能在解决隐匿性微转移方面具有生物学优势，并具有放射生物学基础，可促进不同模式之间的协同作用。此外，尽管比较RP和RT+ADT的观察数据是异质的，而且通常在方法上是有限的，但最近使用现代因果推理框架的分析表明，RT+ADT改善了远处转移控制。不同治疗方式的毒性特征也有显著差异，RT+ADT的早期和长期泌尿系统副作用较少，治疗后悔较少，但治疗期间出现了短暂的激素相关症状和肠道症状。在这里，我们提出，在共享决策模型下，RT+ADT将成为大多数高危局限性前列腺癌男性的首选一线治疗方法，特别是随着现代放疗技术的进步，在保持生活质量的同时提供良好的肿瘤控制。

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引用次数: 0

Hypofractionation/Ultra-hypofractionation for Prostate Cancer Radiotherapy 低分割/超低分割在前列腺癌放疗中的应用

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.004

Deep Chakrabarti , Harshani Green , Alison Tree

Prostate cancer is the most commonly diagnosed cancer in men worldwide. Radiotherapy is an integral component for the treatment of localized prostate cancer. Radiobiologically, prostate cancer is sensitive to an increased dose of radiotherapy delivered per fraction, called “hypofractionation”, due to intrinsic differences in the rate of cancer cell growth and repair of DNA damage. Hypofractionation delivers planned treatment over fewer radiotherapy sessions compared to conventional fractionation and has been shown to be noninferior to conventional fractionation with an acceptable toxicity profile. Ultra-hypofractionation, often delivered via stereotactic body radiotherapy (SBRT), further reduces the number of treatments by using even larger doses per fraction and has shown promising results with high biochemical control rates and low rates of late toxicity. The adoption of hypofractionated and ultra-hypofractionated schedules improves resource utilization in radiation oncology without compromising patient safety or efficacy. Ongoing research continues to refine patient selection, fractionation schemes, and incorporates advanced imaging, precise treatment planning, and motion management techniques to help mitigate toxicity and optimize outcomes in localized intermediate and high-risk disease.

前列腺癌是世界范围内最常见的男性癌症。放射治疗是局部前列腺癌治疗的重要组成部分。放射生物学上，由于癌细胞生长和DNA损伤修复速度的内在差异，前列腺癌对每部分放射治疗剂量的增加（称为“低分割”）很敏感。与传统分割相比，低分割提供了更少的放疗疗程的计划治疗，并且已被证明不低于传统分割，具有可接受的毒性特征。通常通过立体定向体放射治疗（SBRT）进行的超低分割，通过使用更大的剂量进一步减少了治疗次数，并显示出高生化控制率和低晚期毒性的良好结果。低分割和超低分割方案的采用提高了放射肿瘤学的资源利用，而不影响患者的安全性或有效性。正在进行的研究继续改进患者选择、分离方案，并结合先进的成像、精确的治疗计划和运动管理技术，以帮助减轻局部中高危疾病的毒性和优化结果。

{"title":"Hypofractionation/Ultra-hypofractionation for Prostate Cancer Radiotherapy","authors":"Deep Chakrabarti , Harshani Green , Alison Tree","doi":"10.1016/j.semradonc.2025.04.004","DOIUrl":"10.1016/j.semradonc.2025.04.004","url":null,"abstract":"<div><div>Prostate cancer is the most commonly diagnosed cancer in men worldwide. Radiotherapy is an integral component for the treatment of localized prostate cancer. Radiobiologically, prostate cancer is sensitive to an increased dose of radiotherapy delivered per fraction, called “hypofractionation”, due to intrinsic differences in the rate of cancer cell growth and repair of DNA damage. Hypofractionation delivers planned treatment over fewer radiotherapy sessions compared to conventional fractionation and has been shown to be noninferior to conventional fractionation with an acceptable toxicity profile. Ultra-hypofractionation, often delivered via stereotactic body radiotherapy (SBRT), further reduces the number of treatments by using even larger doses per fraction and has shown promising results with high biochemical control rates and low rates of late toxicity. The adoption of hypofractionated and ultra-hypofractionated schedules improves resource utilization in radiation oncology without compromising patient safety or efficacy. Ongoing research continues to refine patient selection, fractionation schemes, and incorporates advanced imaging, precise treatment planning, and motion management techniques to help mitigate toxicity and optimize outcomes in localized intermediate and high-risk disease.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 333-341"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiation Therapy in Node-Positive Prostate Cancer: Current Evidence and Future Directions 淋巴结阳性前列腺癌的放射治疗：目前的证据和未来的方向

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.013

Michael Melton , Antonio Angrisani , Andrew Simpson , Andrew McDonald , Thomas Zilli

The management of node-positive prostate cancer (N1 PCa) remains a subject of ongoing debate, with growing evidence supporting the role of radiation therapy (RT) alongside systemic therapy. Traditionally, N1 disease was considered metastatic; however, advancements in imaging and treatment have redefined its clinical relevance. This narrative review evaluates current evidence, focusing on recent literature and ongoing clinical trials in N1 PCa, both in the definitive and postoperative setting. Prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT) has significantly improved staging accuracy, leading to stage migration and increased consideration of RT for patients with cN1 disease. Both retrospective and prospective studies suggest that RT combined with androgen deprivation therapy (ADT) improves survival compared to ADT alone. Robust data from large clinical trials and ongoing studies support the use of whole-pelvic RT (WPRT) with dose escalation to involved nodes. The optimal management of postoperative pN1 disease remains controversial, with strategies ranging from observation to early salvage or adjuvant RT, often combined with systemic therapy. The ideal RT volume, dose, and systemic therapy combinations continue to be investigated. However, several ongoing trials are paving the way for more refined and effective treatment approaches. This review highlights key trials that may significantly improve the management of N1 PCa in the near future.

淋巴结阳性前列腺癌（N1 PCa）的治疗仍然是一个持续争论的主题，越来越多的证据支持放射治疗（RT）与全身治疗的作用。传统上，N1疾病被认为是转移性的；然而，成像和治疗的进步重新定义了其临床意义。这篇叙述性综述评估了目前的证据，重点关注最近的文献和正在进行的N1 PCa临床试验，包括确诊和术后情况。前列腺特异性膜抗原（PSMA）正电子发射断层扫描-计算机断层扫描（PET/CT）显著提高了分期准确性，导致cN1疾病患者的分期迁移和RT的考虑增加。回顾性和前瞻性研究均表明，与单独ADT相比，RT联合雄激素剥夺治疗（ADT）可提高生存率。来自大型临床试验和正在进行的研究的可靠数据支持使用全盆腔放疗（WPRT），剂量逐渐增加到受累淋巴结。术后pN1疾病的最佳管理仍然存在争议，策略从观察到早期抢救或辅助RT，通常与全身治疗相结合。理想的RT体积、剂量和全身治疗组合仍在研究中。然而，一些正在进行的试验正在为更精细和有效的治疗方法铺平道路。这篇综述强调了在不久的将来可能显著改善N1型前列腺癌管理的关键试验。

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引用次数: 0