编者按：在《肿瘤瞭望-泌尿时讯》2025年EAU大会国际视野的访谈中，来自美国Dana-Farber癌症中心的Alicia K.Morgans教授，分享了她对转移性前列腺癌治疗发展的专业见解。从迫切需要弥合治疗可及性的差距和克服激素抵抗，到多学科合作的重要性以及在先进治疗中维持生活质量，Alicia K.Morgans教授提供了一个全面且深刻的人文视角，揭示了临床医生和患者如今面临的现实问题。

 

Dr.Alicia K.Morgans:我认为在转移性前列腺癌方面面临的最大困难之一，实际上是我们在提供诊疗方面存在差异。这种差异会因国家、国家内的地区以及有时与患者相关的一些因素而有所不同，比如他们的地理位置、经济状况、教育程度等。我认为，我们在应用护理方面存在的这些差异，是我们绝对需要解决的问题，因为我们继续尝试寻找新的治疗方法以及新的药物来治疗前列腺癌患者。

 

目前取得的一些最大突破和成功是，发现了新的治疗前列腺癌的方法，让患者能够活得更久，例如放射性配体疗法在这方面非常有效，特别是镥-177-PSMA-617。此外，我们还看到了针对具有DNA修复缺陷改变的患者的靶向治疗的机会，包括PARP单药或者联合用药。当然，当我们考虑应用这些疗法时，重要的是要确保每个患者都能获得我们所拥有的这些治疗研究所取得的突破性进展。

 

UroStream–Oncology Frontier:What are the current challenges in clinical practice for metastatic prostate cancer，and what breakthroughs have been achieved recently?

 

Alicia K.Morgans:I think some of the biggest difficulties that we have in metastatic prostate cancer is actually a disparity in the way that we are able to provide care.That’s going to differ by country，by region within a country，and sometimes by factors related to patients—like their geography，their economic status，their educational status，and others.And I think that these kinds of differences in the way that we apply care are something that we absolutely need to tackle as we continue to try to find new therapies and to find new ways and drugs to take care of people with prostate cancer.

 

Some of our biggest breakthroughs and successes are that we are finding new ways to treat prostate cancer to keep people alive actually for quite a bit longer，including targeted therapies that target things like PSMA protein.And our radioligand therapies are doing this quite effectively，particularly lutetium PSMA-617.But also we see opportunities for targeted treatments that target patients who have DNA repair defect alterations.And we have PARP inhibitors，and now PARP inhibitor combinations，that can do this.But again，just to circle back，as we think about applying these therapies，it’s really important that we think about ensuring that everybody has access to the amazing breakthroughs that we have.

 

Dr.Alicia K.Morgans:我们多年来一直在努力克服对激素治疗的抵抗，到目前为止，我们仍然知道患者即使使用非常有效的AR通路抑制剂，与单独的雄激素剥夺治疗相比，能够延长进展时间，但最终还是会发展至抵抗阶段。我认为有一些迹象表明，PARP和AR通路抑制剂的联合使用可能允许患者更长时间地暴露于AR通路抑制剂，并延长对这些AR通路抑制剂的耐药时间，特别是对于具有HRR突变的患者。但我认为，到目前为止，我们还没有真正找到克服内分泌治疗耐药性的解决方案。我们仍然需要有其他疗法能够在AR通路抑制剂与ADT单独使用不再有效时替代它们。

 

UroStream–Oncology Frontier:Patients with metastatic prostate cancer often develop resistance to hormone therapy.Based on clinical experience，how do you think we can effectively delay or overcome this resistance problem?

 

Alicia K.Morgans:The resistance to hormone treatments is something that we’ve been working on trying to overcome for many years，and at this point in time we still know that patients do develop resistance—even when we use really effective AR pathway inhibitors to prolong the time to progression as compared to androgen deprivation therapy alone.I think there is some suggestion that combinations of PARP and AR pathway inhibitors may allow a prolonged exposure to—and a longer time to resistance on—those AR pathway inhibitors，particularly for patients with HRR mutations.But I don’t think that we really have the cure，the solution at this point in time to hormone resistance.We still need to have other therapies that can come into the place of the AR pathway inhibitors，in particular when they stop being effective on their own with ADT.

 

Dr.Alicia K.Morgans:我认为治疗疗效与副作用之间的平衡，对于那些每天在我们团队的照顾下以及在这些治疗的影响下生活的患者来说至关重要。而且只有当患者能够服用并耐受这些治疗时，治疗才会有效。每个人在治疗疗效和毒性之间的平衡都会有所不同，因此我们作为医生和临床团队（包括我们的护士和其他团队成员）有责任询问患者他们的感受，并确保我们了解治疗对他们生活质量的影响，包括疲劳、胃肠道反应等。

 

当涉及到血细胞减少症等问题时，我们确实有责任确保安全，并通过监测和干预来平衡治疗的疗效与对骨髓的安全影响。我们纠正可逆的问题，如基础贫血，并确保我们了解如何最好地通过输血或有时改变治疗来支持患者，如果治疗在疗效方面有一定帮助，但确实造成了大量毒性的话。这总是一个权衡。我认为我们工作的一部分就是真正确保我们意识到这种权衡何时对患者有益，何时该停止一种治疗并说“这不再值得努力”。

 

UroStream–Oncology Frontier:Advanced treatments(such as chemotherapy or radionuclide therapy)can have a significant impact on patients’quality of life.How do you balance efficacy and side effects?

 

Alicia K.Morgans:I think that the balance between treatment efficacy and side effects is so critically important to the patients who are living under the care of our teams and under the influence of these treatments every day.And treatments only work if the patients are able to take them and tolerate them.And any individual is going to have a bit of a different balance between treatment efficacy and toxicity，so it’s really incumbent upon all of us as physicians and as clinical teams—including our nurses and other members of the team—to ask patients how they’re doing and make sure that we understand the impacts that the therapies are having on their quality of life，including things like fatigue or GI effects and others.

 

When it comes to things like cytopenias，really we have an obligation to ensure safety，and we balance the effectiveness of treatment with those safety effects on the bone marrow by monitoring and ensuring that we intervene.We reverse things that are reversible，like underlying anemias，and we make sure that we understand how to best support patients with blood transfusions or sometimes changing therapy—if the therapy is somewhat helpful in terms of efficacy but is really causing large amounts of toxicity.It’s always a trade-off.And I think that part of our job is really making sure that we are aware of when that trade-off is benefiting the patient and when it’s time to call it a day on a therapy and say，“This is no longer worth the effort.”

Dr.Alicia K.Morgans:我认为多学科护理对患者来说既是最重要的事情之一，也是提供临床护理最有回报的方面之一。因为当我们以团队形式工作时，这实际上真的有助于教导我们所有人如何成为更好的医生。我们的团队很幸运，因为我们与泌尿科医生、放射肿瘤科医生和医学肿瘤科医生共同在一个地方工作，共享同一个工作区，因此即使在我们同一天出诊时，我们也可以互相交谈并讨论患者病例和护理。

 

我认为同样重要的是，我们有彼此的手机号码，如果我们在走廊上看不到对方或者有人外出，我们可以互相发短信，以便在需要时总是能得到支持。而且我认为拥有一个非常响应的团队也很棒，无论我们是否在诊所，因为问题可能会出现。患者可能出现了新的骨转移，我们可能需要一些针对转移的治疗或一些意外的姑息性放疗——我的放射科同事们总是会非常迅速地响应、前来并帮助患者朝着正确的方向前进。

 

临床中可以见到患者可能出现泌尿系统症状，需要解除梗阻，或者改变了主意说：“我以为我想做放疗，但现在我想做前列腺切除术。”我的泌尿科同事们总是会介入并无缝地推进事情。

 

因此，这种合作和沟通——相互尊重和共享空间——我认为这使得这成为一种美妙的体验，也是为患者提供护理的最佳方式。

 

UroStream–Oncology Frontier:In your clinical team，how do you achieve interdisciplinary collaboration among oncology，urology，and radiotherapy?Can you give an example of how this model can improve patient outcomes?

 

Alicia K.Morgans:I think multidisciplinary care is both one of the most important things for patients，but also one of the most rewarding aspects of providing clinical care.Because when we work as teams，it’s actually really effective in teaching all of us how to be better doctors as well.

 

Our team is lucky in that we are co-localized—practicing in the same place as urologists，radiation oncologists，and medical oncologists—sharing the same workroom and space，so that even on the same day when we’re in clinic，we can talk to each other and discuss patient cases and care.

 

I think also importantly，we have each other’s cell phone numbers，and we can text each other if we don’t see each other in the hallway or if someone is out of town，so that we can always have that support when needed.And I also think that it’s great to have a team that’s very responsive，whether we’re in clinic or not，because questions may come up.A patient may have a new bone metastasis，we may need some metastasis-directed therapy or some palliative radiation that’s unexpected—and my radiation colleagues always respond，come，and help the patient very，very quickly and take things in the right direction.

 

Or a patient may be developing urinary symptoms，need to have an obstruction that’s relieved，or may have changed his mind and said，“I thought I wanted to do radiation，but now I want to have a prostatectomy.”And always，my urology colleagues step in and just move things forward in a seamless way.

 

So that collaboration and communication—mutual respect and shared space—I think is something that makes this a wonderful experience and the best way to practice for patients.