编者按：寡转移性前列腺癌之所以特殊，是因为它既不是完全局限在前列腺内，也不是广泛转移到全身各处，这种中间状态为治疗提供了新的挑战。在近期举行的国家癌症中心泌尿肿瘤学术研讨会暨医学前沿大家谈（NCCU 2025）上，肿瘤瞭望-泌尿时讯特邀德国布伦瑞克市立医院的Peter Hammerer教授分享了寡转移性前列腺癌相关治疗的精彩内容。

 

Peter Hammerer教授：非常感谢您提出这个重要的问题。确实，关于寡转移性疾病的定义存在差异。通常情况下，当我们发现1~3转移病灶时，会将其归类为寡转移状态；不过这一判断还受到所用影像学检查手段的影响。传统方法如CT扫描和骨扫描在检测微小病变方面的能力有限，而近年来出现的新技术（比如PSMA PET成像）大大提高了我们识别体内转移灶的能力。

 

面对这种情况，一个关键的问题随之而来：是否应该对此类患者采取局部治疗？近年来的研究趋势表明，对于那些仅有少量（即1~3个）远处转移的男性前列腺癌患者来说，在接受系统性全身治疗的同时加入针对这些特定区域的局部干预措施，能够带来额外的生存获益。因此，我认为合理的做法是尽可能准确地定位并确认这些可疑区域，并为适合的个体提供个性化的综合治疗方案。总之，将有效的局部疗法纳入整体管理策略之中，对于改善部分患者的长期预后具有重要意义。

 

Oncology Frontier-UroStream：The definition of oligometastatic prostate cancer is not universally agreed upon and exhibits significant heterogeneity.In clinical practice，how do you screen patients who may benefit from surgery?

 

Dr.Peter Hammerer：Well，thank you very much for this really important question.You are absolutely correct，the definition of oligometastatic disease varies.So usually we are talking about oligometastatic disease when we detect between one to three metastatic lesion.However，this also depends on the imaging modality.So we know with CT scan and bone scan，the detection rate is lower compared to new technologies like，for example，PSMA PET.So with PSMA PET scanning，we detect much more metastatic lesions.

 

And the question is always，you know，what to do?Is there a role for local therapy?And there was really a shift within the last years that we realized that for men with low-volume metastatic disease，one to three metastatic lesions，there is indeed a benefit when you offer in addition local therapy.So I think it really makes sense identifying these lesions and offer these men a specific treatment.And I believe that local therapy should be part of the whole treatment options we give to the patient.

Peter Hammerer教授：大型3期临床试验已经证明，对于局部晚期或转移性前列腺癌患者来说，在长期雄激素剥夺疗法（ADT）的基础上加用放射治疗能够带来显著的生存获益。因此，放疗是这类患者的有效选择之一。然而，部分患者可能会出现尿路梗阻症状，比如排尿困难、残余尿量增多等；在这种情况下，我认为根治性前列腺切除术可能比放疗更为有利。

 

但关键在于患者的筛选——只有那些手术切缘阴性几率很高的人才适合接受手术治疗。为此，我们通常会先进行磁共振成像（MRI）和经直肠超声检查，以评估肿瘤的具体位置及其与周围组织的关系。如果发现肿瘤广泛侵犯了括约肌、直肠壁或者膀胱颈部，则该患者就不太适合做手术；这时应该优先考虑全身治疗联合放疗。相反地，对于那些病变局限于前列腺内部且影像学显示仅有少量（如两个）远处转移灶的患者，则可以考虑实施根治性前列腺切除术，并在此基础上制定进一步针对转移病灶及系统性治疗方案。这样不仅能有效控制局部疾病进展，还能提高整体治疗效果。

 

Oncology Frontier-UroStream：For local treatment of the primary lesion，in addition to radical prostatectomy，radiotherapy is also an important option.For different patient populations，what are the advantages and disadvantages of these two methods in terms of tumor control，quality of life，and complications?

 

Dr.Peter Hammerer：So，we know from large phase three clinical trials that there is a proven benefit when we offer radiation therapy in addition to long-term ADT to men with locally advanced disease or metastatic disease.So radiation therapy works for these men.However，some of these men have obstructive symptoms，you know，residual urine，having problems going to the toilet for urinating.So these are men where I believe that radical prostatectomy is more beneficial compared to radiation therapy.

 

But patient selection，I believe is very important.So I would only offer radical prostatectomy to those men where I have a very high chance of having a negative surgical margin.So when we always do MRI scan and transrectal ultrasound before we discuss what we should offer.So if I see a patient with wide involvement of the tumor in the sphincter muscle or in the rectal wall or in the bladder neck，I don’t think that he is a good candidate for surgery.He needs systemic therapy and then we offer radiation therapy.But for those men with really localized disease in the prostate，we do imaging，we see two metastatic lesion，we offer radical prostatectomy with good outcome，with good results，and then we discuss treatment of the metastasis and treatment systemic treatment.

 

Peter Hammerer教授：这是一个很好的问题。我一个月前从柏林的欧洲肿瘤内科学会（ESMO）会议回来，会上有一些有趣的数据显示：例如，对于接受177lu-PSMA放射性配体疗法的患者来说，与标准治疗相比，他们的病情有所改善。因此，我认为提供2个周期的放射性配体疗法可能是非常有益的。

 

当然，在考虑任何治疗方案时，我们都必须权衡其潜在的副作用与给患者带来的益处。特别是对于低负荷疾病状态的患者而言，虽然多达六个疗程的治疗可能会带来较高的不良反应风险，但仅进行一或两次治疗则可能既安全又有效。不过，为了确保这种策略真正对病人有利，还需要更多高质量的临床试验数据来支持这一观点。毕竟，最终目标是找到最适合每位患者的个性化治疗方法，这才是最重要的。

 

Oncology Frontier-UroStream：The emergence of new technologies such as PSMA targeted therapy has brought new possibilities.How do you view its role in oligometastatic diseases?

 

Dr.Peter Hammerer：Again，this is a very good question and you know，I just came back from the ESMO meeting in Berlin，which was one months ago and there were some interesting data showing that for example，when offering，you know，two cycles of radioligand therapy with PSMA Lutetium，there is an improvement compared to standard therapy.So I really believe that，you know，offering maybe two cycles of radioligand therapy are really beneficial.

 

You always have to balance side effects of the treatment with the benefit for the patient.And we know，especially in low volume disease，side effects of radioligand therapy can be high，especially if you offer，you know，up to six cycles.So，I think this is not the way forward，but maybe offering one or two cycles is beneficial，but we need good clinical data，good clinical trials really to prove that there is a benefit for the patient because this is what is important.

 

Peter Hammerer教授

德国布伦瑞克市立医院

德国布伦瑞克市立医院泌尿外科及泌尿肿瘤科主任和教授，该医院是德国最大的医院之一。他的临床和研究重点是前列腺癌、肾癌和膀胱癌，并参与了多项泌尿肿瘤学的II期和III期临床试验。

国际泌尿外科学会（SIU）的理事会成员

德国癌症研究组（AUO）成员

曾任欧洲肿瘤泌尿学会(ESOU)和德国北部泌尿外科大会(Nordkongress)主席

曾任欧洲泌尿外科学院(ESU)理事会成员

曾担任《欧洲泌尿外科》杂志的栏目编辑，并为多家同行评审期刊担任特约审稿人