前列腺癌 (PCa) 局部治疗后生化复发 (BCR) 管理的最新进展，包括使用雄激素受体信号抑制剂 (ARSI)，拓宽了治疗选择的范围。我们的目的是比较具有治愈目的的临床非转移性 PCa 明确局部治疗后 BCR 患者的挽救疗法。2023 年 10 月，我们查询了 PubMed、Scopus 和 Web of Science 数据库，以确定随机对照试验 (RCT) 和前瞻性研究报告关于根治性前列腺切除术 (RP) 或放射治疗 (RT) 后患有 BCR 的 PCa 患者挽救治疗效果的数据。主要终点是无转移生存期 (MFS)，次要终点包括无进展生存期 (PFS) 和总生存期 (OS)。我们纳入了 19 项研究 (n = 9117)；六项试验分析了 RP 后基于 RT 的策略，十项试验分析了 RP±RT 或单独 RT 后基于激素的策略，三项试验分析了其他药物。在一项成对荟萃分析中，与单独放疗相比，在挽救性放疗中添加激素治疗可显着改善 MFS（HR：0.69，95% CI：0.57-0.84，p<0.001）。根据治疗排名分析，在基于放疗的策略中，添加选择性淋巴结放疗和雄激素剥夺疗法（ADT）被发现对于 MFS 而言是最有效的。另一方面，在基于激素的策略中，恩杂鲁胺  ADT 对 MFS 和 OS 均显示出最大的益处。前列腺床放疗、选择性盆腔照射和 ADT 的组合是符合条件的 RP 后 BCR 患者的首选治疗方法我们的分析。对于其余患者，或 RT 后复发的情况，特别是对于具有高风险 BCR 的患者，应考虑 ADT 和 ARSI 的组合。© 2024。作者。

Recent advancements in the management of biochemical recurrence (BCR) following local treatment for prostate cancer (PCa), including the use of androgen receptor signaling inhibitors (ARSIs), have broadened the spectrum of therapeutic options. We aimed to compare salvage therapies in patients with BCR after definitive local treatment for clinically non-metastatic PCa with curative intent.In October 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled trials (RCTs) and prospective studies reporting data on the efficacy of salvage therapies in PCa patients with BCR after radical prostatectomy (RP) or radiation therapy (RT). The primary endpoint was metastatic-free survival (MFS), and secondary endpoints included progression-free survival (PFS) and overall survival (OS).We included 19 studies (n = 9117); six trials analyzed RT-based strategies following RP, ten trials analyzed hormone-based strategies following RP ± RT or RT alone, and three trials analyzed other agents. In a pairwise meta-analysis, adding hormone therapy to salvage RT significantly improved MFS (HR: 0.69, 95% CI: 0.57-0.84, p < 0.001) compared to RT alone. Based on treatment ranking analysis, among RT-based strategies, the addition of elective nodal RT and androgen deprivation therapy (ADT) was found to be the most effective in terms of MFS. On the other hand, among hormone-based strategies, enzalutamide + ADT showed the greatest benefit for both MFS and OS.The combination of prostate bed RT, elective pelvic irradiation, and ADT is the preferred treatment for eligible patients with post-RP BCR based on our analysis. In remaining patients, or in case of post-RT recurrence, especially for those with high-risk BCR, the combination of ADT and ARSI should be considered.© 2024. The Author(s).