指南与共识
ENGLISH ABSTRACT
前列腺癌药物去势治疗随访管理中国专家共识(2024版)
中国前列腺癌研究协作组
作者及单位信息
·
DOI: 10.3760/cma.j.cn112152-20240206-00067
Chinese expert consensus on the follow-up management of patients with prostate cancer receiving medical castration therapy(2024 edition)
Chinese Prostate Cancer Consortium
Ye Dingwei
Authors Info & Affiliations
Chinese Prostate Cancer Consortium
Ye Dingwei
Department of Urology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
·
DOI: 10.3760/cma.j.cn112152-20240206-00067
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摘要

随着诊疗技术的进步,前列腺癌患者的5年生存率显著提升,前列腺癌进入慢性疾病管理时代。雄激素剥夺治疗是晚期前列腺癌患者的基石治疗方案,并贯穿患者治疗的各阶段。前列腺癌药物去势治疗后的疾病进展、治疗相关不良反应以及相关并发症已成为前列腺癌长期管理的一大难题,影响患者的生存及生活质量。除了在诊断和治疗过程中需要注重前列腺癌的疾病管理,更应该密切随访药物去势治疗后患者的整体情况,尤其对于处于疾病治疗关键阶段的患者,应在疾病重要节点(疾病阶段起始点和治疗切换点)监测睾酮或其他指标,避免错过最佳治疗窗口期。前列腺癌随访管理应该兼顾疾病本身治疗阶段特点(疾病分期、既往症状、预后因素及治疗方案)和患者自身诉求,定制个性化的随访策略,更好地提高患者治疗依从性,改善预后。目前中国尚缺乏前列腺癌患者药物去势治疗后随访及生活质量管理的指南或共识,为此,中国前列腺癌研究协作组组织国内相关专家制定了前列腺癌药物去势治疗随访管理中国专家共识(2024版),以期为接受药物去势治疗前列腺癌患者的随访及生活管理提供参考,进一步改善中国前列腺癌患者的预后及生活质量。

前列腺肿瘤;药物去势;随访;生活质量;共识
ABSTRACT

With the advancement of prostate cancer (PCa) diagnosis and treatment technology, the 5-year survival rate has remarkably increased, and PCa has entered the era of chronic disease management. Medical castration therapy remains the cornerstone treatment option for PCa patients, and run throughout the various stages of patient treatment. The disease progression, treatment-related adverse reactions and related complications of PCa patients after medical castration have become a major problem in the long-term management of PCa patients, affecting the survival and quality of life of patients. In addition to focus on the disease management of prostate patients during diagnosis and treatment, patients should be closely followed up after medical castration, especially for those at the critical stage of disease treatment. Testosterone or other indicators should be monitored at important nodes of the disease (the point of initiation disease phase and the point of treatment switch) to avoid missing the optimal treatment window. Follow-up management of PCa should take into account the characteristics of the treatment stage of the disease (disease stage, previous symptoms, prognostic factors and treatment strategy) and patients' own demands, and personalized follow-up strategies should be recommended to better increase patients' treatment compliance and improve patients' prognosis. Currently, there is a lack of guidelines or consensus on the management on the follow-up and quality of life of PCa patients after medical castration in China. Therefore, the Chinese Prostate Cancer Consortium has organized domestic experts to formulate this consensus, with the aim of providing a reference for the management on the follow-up and quality of life of PCa patients receiving medical castration therapy, and to further improve the prognosis and quality of life of PCa patients in China.

Prostate neoplasms;Medical castration;Follow-up;Quality of life;Consensus
Ye Dingwei, Department of Urology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, Email: mocdef.3ab61ileywd
引用本文

中国前列腺癌研究协作组. 前列腺癌药物去势治疗随访管理中国专家共识(2024版)[J]. 中华肿瘤杂志,2024,46(04):285-295.

DOI:10.3760/cma.j.cn112152-20240206-00067

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在全球范围内,前列腺癌作为男性的第2大常见肿瘤,已成为一项重大的公共健康问题 1。随着医学诊疗技术的进步以及前列腺癌早筛意识的不断普及,前列腺癌患者的5年生存率显著改善。美国癌症协会发布的2023年恶性肿瘤统计数据显示,美国前列腺癌患者的5年相对生存率已达97.0%,仅次于甲状腺癌 2。中国前列腺癌患者的5年生存率虽然与美国存在差距,但2012—2015年中国前列腺癌患者的年龄标化5年相对生存率也已从2003—2005年的53.8%提高至66.4% 3。生存时间的延长预示前列腺癌进入慢性疾病管理阶段。在长期的治疗和康复过程中,患者的生活质量、疾病认知、心理状态等问题应在随访期间给予相应的支持和指导。
随访是前列腺癌疾病管理的关键环节 4。通过随访可以评估前列腺癌患者短期及长期肿瘤结局,提高患者对病情的认知,确保治疗依从性;医师可以定期了解患者的治疗效果和病情进展,以便在出现疾病临床进展时指导进一步的治疗,监测治疗的不良反应以及并发症,关注患者治疗体验及生活质量并进行相关心理支持。在前列腺癌的疾病管理中,随访策略的制定不仅要考虑患者具体情况,也需要根据疾病本身的阶段性特点进行个性化随访,从而更精准地达到随访目的。
目前,雄激素剥夺治疗(androgen deprivation therapy,ADT)是除早期前列腺癌外的多个治疗阶段的基石性方案 5,尤其是局部晚期和转移性前列腺癌阶段。前列腺癌患者经ADT后,因雄激素水平下降会导致潮热、性功能障碍、骨质疏松和骨折风险升高、认知改变和抑郁等不良反应,也影响患者的生理和心理健康,从而导致生活质量下降 6。因此,在长期的ADT过程中,疾病治疗关键阶段的患者应在疾病重要节点(疾病阶段起始点和治疗切换点)密切监测睾酮或其他指标,避免错过最佳治疗窗口期。前列腺癌患者应坚持定期规范随访,临床医师也可及时了解病情变化,完善前列腺癌的全程管理。然而,相较于欧美发达国家完善的随访要求,当前我国前列腺癌的随访情况仍有一定的不足之处,失访率较高,主要体现在:(1)当前对于前列腺癌提倡个体化治疗,而针对不同疾病阶段缺乏个体化的随访策略指导;(2)患者自身对疾病认知不到位,对既往病情描述不清或部分遗忘,或因经济、地域等问题,导致自主随访意识薄弱等;(3)根据患者的具体病情,较长的治疗间隔可能会对患者的随访管理构成挑战,增加患者错过预定复诊和后续治疗的风险 3
制定严密的随访计划不但可及时监测前列腺癌患者接受ADT的疾病进展,还可通过对不良反应及伴随疾病的管理提高患者生存及生活质量 4。前列腺癌患者的随访应兼顾疾病本身治疗阶段特点(疾病分期、既往症状、预后因素及治疗方案)和患者自身诉求,定制个性化的随访策略,更好地提高患者治疗依从性,改善患者预后。但是,国内尚缺乏探讨前列腺癌药物去势治疗后随访及生活管理的指南或共识。为此,中国前列腺癌研究协作组组织国内相关专家制定了本共识,以期为前列腺癌患者的随访及生活管理提供参考。
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备注信息
A
叶定伟,复旦大学附属肿瘤医院泌尿外科 复旦大学上海医学院肿瘤学系,上海 200032,Email: mocdef.3ab61ileywd
B
中国前列腺癌研究协作组. 前列腺癌药物去势治疗随访管理中国专家共识(2024版)[J]. 中华肿瘤杂志, 2024, 46(4): 285-295. DOI: 10.3760/cma.j.cn112152-20240206-00067.
C
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