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- Title
Treatment escalation and de-escalation of de-novo metastatic castration-sensitive prostate cancer.
- Authors
Shusuke Akamatsu; Yushi Naito; Jun Nagayama; Yuta Sano; Satoshi Inoue; Kazuna Matsuo; Tomoyasu Sano; Shohei Ishida; Yoshihisa Matsukawa; Masashi Kato
- Abstract
Androgen receptor signaling inhibitors combined with androgen deprivation therapy have become the standard of care for metastatic castration-sensitive prostate cancer (mCSPC), regardless of tumor volume or risk. However, survival of approximately one-third of these patients has not improved, necessitating further treatment escalation. On the other hand, for patients with oligometastatic mCSPC, there is an emerging role for local radiation therapy. Although data remain scarce, it is expected that treatment of both primary tumor as well as metastasis-directed therapy may improve survival outcomes. In these patients, systemic therapy may be de-escalated to intermittent therapy. However, precise risk stratification is necessary for risk-based treatment escalation or de-escalation. In addition to risk stratification based on clinical parameters, research has been conducted to incorporate genomic and/or transcriptomic data into risk stratification. In future, an integrated risk model is expected to precisely stratify patients and guide treatment strategies. Here, we first review the transition of the standard treatment for mCSPC over the last decade and further discuss the newest concept of escalating or de-escalating treatment using a multi-modal approach based on the currently available literature.
- Subjects
CASTRATION-resistant prostate cancer; ANDROGEN receptors; PROSTATE cancer; ANDROGEN deprivation therapy; SURVIVAL rate; RADIOTHERAPY
- Publication
Nagoya Journal of Medical Science, 2024, Vol 86, Issue 2, p169
- ISSN
0027-7622
- Publication type
Article
- DOI
10.18999/nagjms.86.2.169