前列腺癌与精准医学

Precision medicine and prostate cancer

当精准医疗的理念遇到后人类基因组计划时代,前列腺癌的临床诊疗迎来了"再解读"和"新导向"的绝佳机遇。前列腺癌作为男性肿瘤的头号杀手,其按传统理念治疗的效果提升或遇瓶颈、或待突破,而按精准医疗理念治疗初现成效。通过精准医疗手段对患者进行临床再分型,对前列腺癌经典的雄激素剥夺治疗(ADT)、化学治疗乃至放射治疗策略具有潜在的优化价值;当前列腺癌的传统治疗渐失效果时,前列腺癌分子分型图谱的描绘和靶向治疗的开发有望成为新的突破点;与此同时,精准医疗的探索还促使免疫环境改造、肿瘤新抗原预测以及类器官培养等新型治疗理念进入前列腺癌的研究领域。精准医学正在"加速"走进人们视野,未来在前列腺癌诊疗中或将具有广阔的应用前景。然而,现阶段肿瘤精准医疗的投入与获益比仍远低于大众的心理预期。同时,与诸多新兴理念一样,精准医疗背后潜在的巨大市场不可避免滋生了过热的商业宣传。在这种现状下,科研工作者与临床医患双方充分沟通、合作,以及政府卫生管理部门对行业的规范和引导,是保证精准医疗造福人类健康正确前行方向的必由之路。

IN post-human genomic era, the concept of precision medicine has provided opportunities for ＂reinterpretation＂ and ＂new orientation＂ for cancer therapy including prostate cancer. Prostate cancer is the leading cause of cancer-related death in men, and its traditional treatment meets bottleneck and needs broken through, while the concept of precision medicine is starting to have positive effect. Precision medicine has potential values in optimizing the clinical reclassification of patients, androgen deprivation therapy（ADT）, chemotherapy, and radiation therapy strategies for prostate cancer. When traditional treatment of prostate cancer gradually loses efficacy, the prostate cancer molecular subtyping map and the development of targeted therapies are expected to bring new breakthrough. At the same time, precision medicine also prompts new therapeutic concepts for prostate cancer, such as reconstruction of the immune environment, tumor-specific neoantigens prediction, and organoid culture system. The future of precision medicine has been widely embraced and it will have promising application in the diagnosis and treatment of prostate cancer. However, currently the benefit of precision treatment of cancer is still far below the public expectations. Like for many emerging concepts, the potentially huge market behind precision medicine inevitably breeds overheated commercial propaganda. Full communication and cooperation of scientific researchers with clinical doctors and patients, and standardization and guidance of health administration are the keys to ensure that precision medicine benefits for human health.