Metastatik Prostat Kanserine Yaklaşım
Özet
Metastatik prostat kanseri tedavisinde androjen deprivasyon tedavisi (ADT), küratif tedavi sonrası PSA nüksünde, lokal ileri evre veya metastatik hastalıkta standart yaklaşım olarak yer almaktadır. Hastalığın hacim ve risk sınıflaması CHAARTED ve LATITUDE çalışmalarıyla valide edilmiş olup, prognostik faktörler arasında metastaz sayısı, ISUP derecesi ve PSA düzeyleri kritik rol oynamaktadır. İlk basamak hormonal tedavide LH-RH agonist/antagonistleri veya orşiektomi kullanılırken, kardiyovasküler hastalığı olanlarda antagonistler tercih edilmektedir. Aralıklı ADT, yan etkileri azaltmak ve maliyet avantajı sağlamak için uygun hastalarda 6-9 ay süreyle uygulanabilir. Son yıllarda sürekli ADT ile kombine edilen dosetaksel kemoterapisi veya yeni nesil hormonal tedaviler (abirateron asetat + prednizon), tek başına ADT'ye kıyasla genel ve progresyonsuz sağ kalımı anlamlı derecede artırarak ilk başvuruda metastatik olan hastalarda standart tedavi haline gelmiştir. Tedavi seçimi hasta tercihi, yan etki profili, dosetaksel uygunluğu ve maliyete göre şekillenmektedir. Ayrıca, düşük hacimli metastatik hastalığı olan seçilmiş vakalarda primer tümöre yönelik prostat radyoterapisinin genel sağ kalım avantajı sağladığı gösterilmiştir.
Androgen deprivation therapy (ADT) is the standard approach in metastatic prostate cancer treatment for PSA recurrence after curative therapy, locally advanced stage, or metastatic disease. The volume and risk classification of the disease have been validated by the CHAARTED and LATITUDE trials, with the number of metastases, ISUP grade, and PSA levels playing critical roles among prognostic factors. While LH-RH agonists/antagonists or orchiectomy are used in first-line hormonal therapy, antagonists are preferred in patients with cardiovascular disease. Intermittent ADT can be applied for 6-9 months in eligible patients to reduce side effects and provide a cost advantage. In recent years, docetaxel chemotherapy or next-generation hormonal therapies (abiraterone acetate + prednisone) combined with continuous ADT have significantly increased overall and progression-free survival compared to ADT alone, becoming the standard treatment for patients presenting with metastatic disease. Treatment selection is shaped by patient preference, side effect profiles, docetaxel eligibility, and cost. Additionally, radiation therapy to the primary tumor has been shown to provide an overall survival benefit in selected cases with low-volume metastatic disease.
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