Ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u (kh\u00f4ng \u0111\u1ed3ng th\u1eddi) \u0111\u1ed1i v\u1edbi b\u1ec7nh khu tr\u00fa ho\u1eb7c c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ngay t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n (\u0111\u1ed3ng th\u1eddi). \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh di c\u0103n, c\u00f3 nhi\u1ec1u ph\u00e2n lo\u1ea1i kh\u00e1c nhau \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o qu\u1ea3n l\u00fd b\u1ec7nh t\u1ed1i \u01b0u. \u0110\u1ea7u ti\u00ean, s\u1ef1 ti\u1ebfn tri\u1ec3n t\u1eeb kh\u00f4ng di c\u0103n sang di c\u0103n trong khi \u0111ang \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf hormone x\u00e1c \u0111\u1ecbnh b\u1ec7nh kh\u00e1ng l\u1ea1i li\u1ec7u ph\u00e1p c\u1eaft b\u1ecf tinh ho\u00e0n v\u00e0 s\u1ebd \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn trong ch\u01b0\u01a1ng ti\u1ebfp theo (c\u0169ng nh\u01b0 b\u1ec7nh kh\u00e1ng l\u1ea1i li\u1ec7u ph\u00e1p c\u1eaft b\u1ecf tinh ho\u00e0n kh\u00f4ng di c\u0103n). \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh di c\u0103n m\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb hormone tr\u01b0\u1edbc \u0111\u00f3 – \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n nh\u1ea1y c\u1ea3m v\u1edbi hormone (mHSPC) – h\u1ecd c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ec7nh di c\u0103n th\u1ec3 t\u00edch th\u1ea5p ho\u1eb7c cao d\u1ef1a tr\u00ean th\u1eed nghi\u1ec7m CHAARTED, trong \u0111\u00f3 th\u1ec3 t\u00edch cao \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u22654 di c\u0103n x\u01b0\u01a1ng v\u1edbi m\u1ed9t di c\u0103n b\u00ean ngo\u00e0i khung x\u01b0\u01a1ng tr\u1ee5c ho\u1eb7c b\u1ea5t k\u1ef3 di c\u0103n n\u1ed9i t\u1ea1ng n\u00e0o (Sweeney et al., 2015). Trong c\u00e1c ph\u1ea7n ti\u1ebfp theo, vi\u1ec7c qu\u1ea3n l\u00fd ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n nh\u1ea1y c\u1ea3m v\u1edbi hormone s\u1ebd \u0111\u01b0\u1ee3c xem x\u00e9t. \u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0 ch\u0103m s\u00f3c \u0111a chuy\u00ean khoa r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi vi\u1ec7c qu\u1ea3n l\u00fd nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y v\u00ec th\u01b0\u1eddng c\u1ea7n k\u1ebft h\u1ee3p c\u00e1c li\u1ec7u ph\u00e1p to\u00e0n th\u00e2n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u.\u00a0
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Ch\u1ea9n \u0111o\u00e1n\u00a0<\/strong><\/p>\n\n\n\n Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh di c\u0103n th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua h\u00ecnh \u1ea3nh m\u00f4 m\u1ec1m v\u00e0 x\u01b0\u01a1ng b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p h\u00ecnh \u1ea3nh th\u00f4ng th\u01b0\u1eddng (CT, MRI, ch\u1ee5p x\u1ea1 h\u00ecnh x\u01b0\u01a1ng) ho\u1eb7c th\u1ebf h\u1ec7 m\u1edbi (PET\/CT). M\u1eb7c d\u00f9 b\u1ec7nh \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ea5t k\u1ec3 ph\u01b0\u01a1ng ph\u00e1p h\u00ecnh \u1ea3nh n\u00e0o \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, h\u1ea7u h\u1ebft c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng (s\u1ebd \u0111\u01b0\u1ee3c xem x\u00e9t) \u0111\u1ec1u d\u1ef1a tr\u00ean ch\u1ea9n \u0111o\u00e1n b\u1ec7nh di c\u0103n b\u1eb1ng h\u00ecnh \u1ea3nh th\u00f4ng th\u01b0\u1eddng v\u00e0 do \u0111\u00f3 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh di c\u0103n d\u01b0\u01a1ng t\u00ednh tr\u00ean h\u00ecnh \u1ea3nh PET\/CT th\u00f4ng th\u01b0\u1eddng v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u k\u1ef9 l\u01b0\u1ee1ng. <\/p>\n\n\n\n Vi\u1ec7c x\u00e1c nh\u1eadn m\u00f4 h\u1ecdc b\u1ec7nh di c\u0103n kh\u00f4ng b\u1eaft bu\u1ed9c \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n, \u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh di c\u0103n kh\u00f4ng \u0111\u1ed3ng th\u1eddi. Tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ea9n \u0111o\u00e1n m\u00f4 h\u1ecdc ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t, n\u00ean xem x\u00e9t sinh thi\u1ebft tuy\u1ebfn ti\u1ec1n li\u1ec7t ho\u1eb7c sinh thi\u1ebft t\u1ed5n th\u01b0\u01a1ng di c\u0103n \u0111\u1ec3 x\u00e1c nh\u1eadn b\u1ec7nh. Ngo\u00e0i ra, n\u00ean xem x\u00e9t x\u00e9t nghi\u1ec7m di truy\u1ec1n d\u00f2ng m\u1ea7m v\u00e0 d\u00f2ng soma cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n v\u00ec 0,10% b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh di c\u0103n c\u00f3 \u0111\u1ed9t bi\u1ebfn s\u1eeda ch\u1eefa DNA c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c li\u1ec7u ph\u00e1p nh\u1eafm m\u1ee5c ti\u00eau trong b\u1ec7nh giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n (Pritchard et al., 2016). H\u01b0\u1edbng d\u1eabn v\u1ec1 ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a AUA v\u00e0 H\u01b0\u1edbng d\u1eabn v\u1ec1 ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t c\u1ee7a NCCN khuy\u1ebfn ngh\u1ecb x\u00e9t nghi\u1ec7m di truy\u1ec1n (d\u00f2ng m\u1ea7m v\u00e0 d\u00f2ng soma) cho b\u1ec7nh nh\u00e2n ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n. C\u00e1c x\u00e9t nghi\u1ec7m c\u1ee5 th\u1ec3 n\u00ean bao g\u1ed3m BRCA1, BRCA2, ATM, PALB2, CHEK2, HOXB13, MLH1, MSH2, MSH6 v\u00e0 PMS2 \u0111\u1ec3 x\u00e9t nghi\u1ec7m di truy\u1ec1n v\u00e0 BRCA1, BRCA2, ATM, PALB2, FANCA, RAD51D, CHEK2, CDK12, MSI-H v\u00e0 t\u00ecnh tr\u1ea1ng dMMR trong x\u00e9t nghi\u1ec7m kh\u1ed1i u soma.<\/p>\n\n\n\n Ti\u00ean l\u01b0\u1ee3ng<\/strong><\/p>\n\n\n\n Ti\u00ean l\u01b0\u1ee3ng trong mHSPC r\u1ea5t kh\u00e1c nhau, v\u00e0 trong l\u1ecbch s\u1eed, b\u1ec7nh nh\u00e2n m\u1eafc ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n th\u01b0\u1eddng c\u00f3 th\u1eddi gian s\u1ed1ng th\u00eam trung b\u00ecnh (OS) th\u1ea5p, ch\u1ec9 30 th\u00e1ng k\u1ec3 t\u1eeb khi ch\u1ea9n \u0111o\u00e1n (Tangen et al., 2012). K\u1ec3 t\u1eeb khi c\u00f3 s\u1ef1 ra \u0111\u1eddi c\u1ee7a docetaxel, li\u1ec7u ph\u00e1p hormone ti\u00ean ti\u1ebfn v\u00e0 s\u1ef1 k\u1ebft h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, th\u1eddi gian s\u1ed1ng th\u00eam trung b\u00ecnh hi\u1ec7n nay v\u01b0\u1ee3t qu\u00e1 48 th\u00e1ng (Fizazi et al., 2022; Smith et al., 2022). \u0110i\u1ec1u th\u00fa v\u1ecb l\u00e0, \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh kh\u00f4ng \u0111\u1ed3ng th\u1eddi v\u00e0 di c\u0103n v\u1edbi th\u1ec3 t\u00edch nh\u1ecf, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t cao h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u1ed3ng th\u1eddi ho\u1eb7c di c\u0103n v\u1edbi th\u1ec3 t\u00edch l\u1edbn (th\u1eddi gian s\u1ed1ng th\u00eam trung b\u00ecnh l\u00e0 92,4 th\u00e1ng so v\u1edbi 43,2 th\u00e1ng) (Francini et al., 2018). H\u01a1n n\u1eefa, v\u1ecb tr\u00ed di c\u0103n c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng. Trong m\u1ed9t nghi\u00ean c\u1ee9u t\u1ed5ng quan quy m\u00f4 l\u1edbn v\u1ec1 c\u01a1 s\u1edf d\u1eef li\u1ec7u SEER, b\u1ec7nh nh\u00e2n ch\u1ec9 m\u1eafc b\u1ec7nh di c\u0103n h\u1ea1ch b\u1ea1ch huy\u1ebft c\u00f3 th\u1eddi gian s\u1ed1ng s\u00f3t trung b\u00ecnh l\u00e0 43 th\u00e1ng, so v\u1edbi 24 th\u00e1ng \u0111\u1ed1i v\u1edbi b\u1ec7nh di c\u0103n x\u01b0\u01a1ng, 16 th\u00e1ng \u0111\u1ed1i v\u1edbi b\u1ec7nh di c\u0103n n\u1ed9i t\u1ea1ng v\u00e0 14 th\u00e1ng \u0111\u1ed1i v\u1edbi b\u1ec7nh di c\u0103n c\u1ea3 x\u01b0\u01a1ng v\u00e0 n\u1ed9i t\u1ea1ng (Gandaglia et al., 2015). Tuy nhi\u00ean, \u0111i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0 nghi\u00ean c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi c\u00f3 c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p hi\u1ec7n \u0111\u1ea1i \u0111\u1ec3 qu\u1ea3n l\u00fd b\u1ec7nh di c\u0103n. <\/p>\n\n\n\n Th\u00f4ng tin ti\u00ean l\u01b0\u1ee3ng b\u1ed5 sung c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c thu th\u1eadp t\u1eeb \u0111\u00e1p \u1ee9ng sinh h\u00f3a v\u1edbi li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf androgen ban \u0111\u1ea7u (ADT). T\u1ea5t c\u1ea3 c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng nh\u1eb1m m\u1ee5c \u0111\u00edch ch\u1eefa kh\u1ecfi b\u1ec7nh di c\u0103n \u0111\u1ec1u d\u1ef1a v\u00e0o ADT (c\u1eaft b\u1ecf tinh ho\u00e0n, ch\u1ea5t \u0111\u1ed1i kh\u00e1ng ho\u1eb7c ch\u1ea5t ch\u1ee7 v\u1eadn LHRH) \u0111\u1ec3 \u1ee9c ch\u1ebf testosterone n\u1ec1n. D\u1eef li\u1ec7u t\u1eeb nghi\u00ean c\u1ee9u SQOG 9346 (\u0111i\u1ec1u tr\u1ecb ADT gi\u00e1n \u0111o\u1ea1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb ADT li\u00ean t\u1ee5c cho mHSPC) cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ea1t m\u1ee9c PSA th\u1ea5p nh\u1ea5t <0,2 ng\/mL sau 7 th\u00e1ng \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1eddi gian s\u1ed1ng th\u00eam trung b\u00ecnh l\u00e0 75 th\u00e1ng so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c PSA th\u1ea5p nh\u1ea5t t\u1eeb \u200b\u200b0,2 \u0111\u1ebfn 4 ng\/mL (trung b\u00ecnh 44 th\u00e1ng) ho\u1eb7c > 4 ng\/mL (trung b\u00ecnh 13 th\u00e1ng) (Hussain, 2006).<\/p>\n\n\n\n \u0110i\u1ec1u tr\u1ecb ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n nh\u1ea1y c\u1ea3m v\u1edbi hormone (mHSPC)<\/strong>: <\/p>\n\n\n\n \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n<\/em><\/strong><\/p>\n\n\n\n \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n mHSPC, \u0111i\u1ec1u tr\u1ecb b\u1eaft \u0111\u1ea7u b\u1eb1ng vi\u1ec7c \u1ee9c ch\u1ebf testosterone th\u00f4ng qua ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tinh ho\u00e0n ho\u1eb7c li\u1ec7u ph\u00e1p ch\u1ea5t ch\u1ee7 v\u1eadn\/\u0111\u1ed1i kh\u00e1ng LHRH (Cornford et al., 2021; Lowrance et al., 2023; Schaeffer et al., 2022). Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p (v\u00ed d\u1ee5: nguy c\u01a1 ch\u00e8n \u00e9p t\u1ee7y s\u1ed1ng), vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ea5t \u0111\u1ed1i kh\u00e1ng LHRH ho\u1eb7c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tinh ho\u00e0n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 t\u0103ng \u0111\u1ed9t bi\u1ebfn testosterone. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n di c\u0103n x\u01b0\u01a1ng, n\u1ebfu b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ch\u1ea5t ch\u1ee7 v\u1eadn LHRH, vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c kh\u00e1ng androgen kh\u00f4ng steroid c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c tri\u1ec7u ch\u1ee9ng do s\u1ef1 t\u0103ng \u0111\u1ed9t bi\u1ebfn testosterone g\u00e2y ra. Thu\u1ed1c kh\u00e1ng androgen kh\u00f4ng steroid \u0111\u01a1n \u0111\u1ed9c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho mHSPC. Ngo\u00e0i ra, H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t ti\u1ebfn tri\u1ec3n c\u1ee7a AUA khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf androgen k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng androgen kh\u00f4ng steroid (Lowrance v\u00e0 c\u1ed9ng s\u1ef1, 2023) v\u00ec c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y ph\u01b0\u01a1ng ph\u00e1p n\u00e0y kh\u00f4ng k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng th\u00eam m\u1ed9t c\u00e1ch \u0111\u00e1ng k\u1ec3 (Nh\u00f3m h\u1ee3p t\u00e1c th\u1eed nghi\u1ec7m ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t, 2000) v\u00e0 c\u00f3 nh\u1eefng li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p m\u1edbi h\u01a1n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 hi\u1ec7u qu\u1ea3. Sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, b\u1ec7nh nh\u00e2n m\u1eafc mHSPC n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p v\u1edbi docetaxel, thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p androgen ho\u1eb7c thu\u1ed1c nh\u1eafm m\u1ee5c ti\u00eau th\u1ee5 th\u1ec3 androgen (AR). Th\u00eam v\u00e0o \u0111\u00f3, ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 “li\u1ec7u ph\u00e1p ba thu\u1ed1c”, trong \u0111\u00f3 k\u1ebft h\u1ee3p ADT, docetaxel, v\u00e0 ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c nh\u1eafm m\u1ee5c ti\u00eau th\u1ee5 th\u1ec3 androgen (AR) ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p androgen. <\/p>\n\n\n\n \u0110i\u1ec1u tr\u1ecb theo d\u00f5i kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc mHSPC tr\u1eeb khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00f3 ti\u00ean l\u01b0\u1ee3ng s\u1ed1ng gi\u1ea3m nghi\u00eam tr\u1ecdng (d\u01b0\u1edbi 5 n\u0103m). Tr\u01b0\u1eddng h\u1ee3p duy nh\u1ea5t kh\u00e1c m\u00e0 li\u1ec7u ph\u00e1p to\u00e0n th\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c tr\u00ec ho\u00e3n l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p nh\u1eafm v\u00e0o di c\u0103n \u0111\u1ed1i v\u1edbi b\u1ec7nh di c\u0103n \u00edt (s\u1ebd \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn sau). <\/p>\n\n\n\n Docetaxel. <\/mark><\/strong><\/p>\n\n\n\n Docetaxel l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf vi \u1ed1ng \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m k\u1ebft h\u1ee3p v\u1edbi li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf androgen (ADT) cho mHSPC trong ba th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng giai \u0111o\u1ea1n III: CHAARTED, STAMPEDE v\u00e0 GETUG-15. Trong th\u1eed nghi\u1ec7m GETUG-15, 385 nam gi\u1edbi \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT ho\u1eb7c ADT c\u1ed9ng v\u1edbi docetaxel (75 mg\/m2 \u0111\u01b0\u1ee3c d\u00f9ng trong chu k\u1ef3 21 ng\u00e0y, t\u1ed1i \u0111a 9 chu k\u1ef3) v\u1edbi \u0111i\u1ec3m cu\u1ed1i ch\u00ednh l\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t t\u1ed5ng th\u1ec3 (Gravis et al., 2013). Th\u1eddi gian s\u1ed1ng trung b\u00ecnh (OS) l\u00e0 58,9 th\u00e1ng so v\u1edbi 54,2 th\u00e1ng (HR = 1,01, 95% CI 0,75\u20131,62) v\u1edbi b\u1ed1n tr\u01b0\u1eddng h\u1ee3p t\u1eed vong li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb. Th\u1eed nghi\u1ec7m CHAARTED \u0111\u00e3 ph\u00e2n ng\u1eabu nhi\u00ean 790 b\u1ec7nh nh\u00e2n v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT ho\u1eb7c ADT k\u1ebft h\u1ee3p v\u1edbi docetaxel (75 mg\/m2 \u0111\u01b0\u1ee3c d\u00f9ng trong chu k\u1ef3 21 ng\u00e0y, t\u1ed1i \u0111a 6 chu k\u1ef3) v\u1edbi \u0111i\u1ec3m cu\u1ed1i ch\u00ednh l\u00e0 th\u1eddi gian s\u1ed1ng t\u1ed5ng th\u1ec3 (Sweeney et al., 2015). Trong ph\u00e2n t\u00edch ch\u00ednh, ADT c\u1ed9ng v\u1edbi docetaxel \u0111\u00e3 c\u1ea3i thi\u1ec7n OS v\u1edbi th\u1eddi gian s\u1ed1ng trung b\u00ecnh l\u00e0 57,6 th\u00e1ng so v\u1edbi 44,0 th\u00e1ng (HR = 0,61, 95% CI 0,47\u20130,80, p < 0,01); Tuy nhi\u00ean, khi ph\u00e2n t\u1ea7ng theo th\u1ec3 t\u00edch b\u1ec7nh, l\u1ee3i \u00edch c\u1ee7a li\u1ec7u ph\u00e1p ch\u1ec9 \u0111\u01b0\u1ee3c th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u1edf th\u1ec3 t\u00edch l\u1edbn (th\u1eddi gian s\u1ed1ng th\u00eam trung b\u00ecnh 49,2 th\u00e1ng so v\u1edbi 32,2 th\u00e1ng; HR = 0,60, 95% CI 0,45\u20130,81, p < 0,01). Cu\u1ed1i c\u00f9ng, th\u1eed nghi\u1ec7m STAMPEDE \u0111\u00e3 ph\u00e2n ng\u1eabu nhi\u00ean c\u00e1c b\u1ec7nh nh\u00e2n m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n ho\u1eb7c b\u1ec7nh ti\u1ebfn tri\u1ec3n t\u1ea1i ch\u1ed7 c\u00f3 nguy c\u01a1 cao v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT (1184) ho\u1eb7c nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi docetaxel (592; 75 mg\/m2 \u0111\u01b0\u1ee3c d\u00f9ng trong chu k\u1ef3 21 ng\u00e0y, t\u1ed1i \u0111a 6 chu k\u1ef3) (James et al., 2016). T\u1ea1i th\u1eddi \u0111i\u1ec3m ph\u00e2n t\u00edch, khi so s\u00e1nh v\u1edbi ADT, s\u1ef1 k\u1ebft h\u1ee3p v\u1edbi docetaxel \u0111\u00e3 gi\u00fap k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng th\u00eam (HR = 0,78, 95% CI 0,66\u20130,93, p < 0,01). Trong m\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u1ee7a c\u1ea3 ba nghi\u00ean c\u1ee9u, hi\u1ec7u qu\u1ea3 \u01b0\u1edbc t\u00ednh c\u1ee7a vi\u1ec7c b\u1ed5 sung docetaxel l\u00e0 HR 0,77 (95% CI 0,68\u20130,87) \u0111\u1ed1i v\u1edbi nguy c\u01a1 t\u1eed vong, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi vi\u1ec7c gi\u1ea3m 94 ca t\u1eed vong tr\u00ean 1000 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb (Sathianathen et al., 2018). C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh (\u0111\u1ed9 3\u20134: 12-15%), gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh k\u00e8m s\u1ed1t (\u0111\u1ed9 3\u20134: 6-12%) v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng. Nh\u00ecn chung, nh\u1eefng d\u1eef li\u1ec7u n\u00e0y cho th\u1ea5y l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c b\u1ed5 sung h\u00f3a tr\u1ecb li\u1ec7u docetaxel v\u00e0o li\u1ec7u ph\u00e1p ADT ti\u00eau chu\u1ea9n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc mHSPC, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ed1i u l\u1edbn.<\/p>\n\n\n\n Thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p androgen.<\/mark><\/strong> <\/strong>Nh\u01b0 \u0111\u00e3 \u0111\u01b0\u1ee3c xem x\u00e9t tr\u01b0\u1edbc \u0111\u00f3, abiraterone acetate l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p androgen. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y trong mHSPC \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong hai th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng l\u1edbn: LATTITUDE v\u00e0 STAMPEDE nh\u00e1nh G. Trong th\u1eed nghi\u1ec7m LATTITUDE, 1199 b\u1ec7nh nh\u00e2n m\u1eafc mHSPC v\u00e0 c\u00f3 \u00edt nh\u1ea5t hai \u0111\u1eb7c \u0111i\u1ec3m nguy c\u01a1 cao (nh\u00f3m \u0111\u1ed9 4\u20135, ba ho\u1eb7c nhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng, ho\u1eb7c di c\u0103n n\u1ed9i t\u1ea1ng) \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m ch\u1ec9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT ho\u1eb7c nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi abiraterone acetate (1000 mg\/ng\u00e0y) c\u00f9ng v\u1edbi prednisone (5 mg\/ng\u00e0y) (Fizazi et al., 2017). V\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 30 th\u00e1ng, vi\u1ec7c b\u1ed5 sung abiraterone c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t t\u1ed5ng th\u1ec3 (th\u1eddi gian trung b\u00ecnh ch\u01b0a \u0111\u1ea1t \u0111\u01b0\u1ee3c so v\u1edbi 34,7 th\u00e1ng; HR 5 0,67, 95% CI 0,51\u20130,76, p < 0,001). Ngo\u00e0i ra, abiraterone c\u00f2n li\u00ean quan \u0111\u1ebfn s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n b\u1ec7nh tr\u00ean phim ch\u1ee5p X-quang, th\u1eddi gian \u0111\u1ebfn khi c\u01a1n \u0111au ti\u1ebfn tri\u1ec3n, th\u1eddi gian \u0111\u1ebfn c\u00e1c li\u1ec7u ph\u00e1p th\u1ee9 ph\u00e1t v\u00e0 th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n PSA (Fizazi et al., 2017). Trong nh\u00e1nh G c\u1ee7a nghi\u00ean c\u1ee9u STAMPEDE, 1917 b\u1ec7nh nh\u00e2n m\u1eafc mHSPC v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ecdn m\u1eafc b\u1ec7nh ti\u1ebfn tri\u1ec3n t\u1ea1i ch\u1ed7 c\u00f3 nguy c\u01a1 cao \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m ch\u1ec9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT ho\u1eb7c nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi abiraterone acetate (1000 mg\/ng\u00e0y) c\u00f9ng v\u1edbi prednisone (5 mg\/ng\u00e0y) (James et al., 2017). V\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 40 th\u00e1ng, vi\u1ec7c b\u1ed5 sung abiraterone \u0111\u00e3 l\u00e0m gi\u1ea3m nguy c\u01a1 t\u1eed vong (HR = 0,61, 95% CI 0,49\u20130,75, p < 0,001) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n mHSPC v\u00e0 d\u1eabn \u0111\u1ebfn c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng kh\u00f4ng ti\u1ebfn tri\u1ec3n b\u1ec7nh.<\/p>\n\n\n\n C\u00e1c thu\u1ed1c nh\u1eafm m\u1ee5c ti\u00eau th\u1ee5 th\u1ec3 androgen<\/mark><\/strong>.\u00a0Hi\u1ec7n nay c\u00f3 hai thu\u1ed1c \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb mHSPC k\u1ebft h\u1ee3p v\u1edbi ADT; enzalutamide v\u00e0 apalutamide d\u1ef1a tr\u00ean d\u1eef li\u1ec7u t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m ARCHES, ENZAMET v\u00e0 TITAN. Trong th\u1eed nghi\u1ec7m ARCHES, 1150 nam gi\u1edbi m\u1eafc mHSPC (18% \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng docetaxel tr\u01b0\u1edbc \u0111\u00f3) \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m ch\u1ec9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi enzalutamide (160 mg\/ng\u00e0y) v\u1edbi th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n b\u1ec7nh tr\u00ean h\u00ecnh \u1ea3nh X-quang l\u00e0 \u0111i\u1ec3m cu\u1ed1i ch\u00ednh (Armstrong et al., 2019). V\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 44,6 th\u00e1ng, enzalutamide c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n b\u1ec7nh (HR = 0,39, 95% CI 0,30\u20130,52, p < 0,001); m\u1ed9t ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c th\u1ea5y b\u1ea5t k\u1ec3 th\u1ec3 t\u00edch b\u1ec7nh (cao so v\u1edbi th\u1ea5p) ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng docetaxel tr\u01b0\u1edbc \u0111\u00f3. Trong th\u1eed nghi\u1ec7m ENZAMET, 1125 nam gi\u1edbi m\u1eafc mHSPC (15-17% \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng docetaxel tr\u01b0\u1edbc \u0111\u00f3) \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi thu\u1ed1c kh\u00e1ng androgen kh\u00f4ng steroid th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t\/th\u1ee9 hai so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi enzalutamide (160 mg\/ng\u00e0y) v\u1edbi \u0111i\u1ec3m cu\u1ed1i ch\u00ednh l\u00e0 th\u1eddi gian s\u1ed1ng th\u00eam to\u00e0n b\u1ed9 (OS) (Davis et al., 2019). Sau th\u1eddi gian theo d\u00f5i trung b\u00ecnh 34 th\u00e1ng, enzalutamide cho th\u1ea5y s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 OS (t\u1ef7 l\u1ec7 s\u1ed1ng th\u00eam 3 n\u0103m l\u00e0 80% so v\u1edbi 72%; HR = 0,67, 95% CI 0,52\u20130,86, p = 0,002), c\u0169ng nh\u01b0 c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n PSA. Cu\u1ed1i c\u00f9ng, trong th\u1eed nghi\u1ec7m TITAN, 525 nam gi\u1edbi m\u1eafc mHSPC (10% \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng docetaxel tr\u01b0\u1edbc \u0111\u00f3) \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT \u0111\u01a1n thu\u1ea7n so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ed9ng v\u1edbi apalutamide 240 mg\/ng\u00e0y, v\u1edbi \u0111i\u1ec3m cu\u1ed1i ch\u00ednh l\u00e0 th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n tr\u00ean h\u00ecnh \u1ea3nh X-quang v\u00e0 OS (Chi et al., 2019). V\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 23 th\u00e1ng, t\u1ef7 l\u1ec7 s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n b\u1ec7nh (rPFS) sau 24 th\u00e1ng (68,2% so v\u1edbi 47,5%; HR = 0,48, 95% CI 0,39\u20130,60, p < 0,001) v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng to\u00e0n b\u1ed9 (OS) (82,4% so v\u1edbi 73,5%, HR = 0,67, 95% CI 0,51\u20130,89, p = 0,005) \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n khi b\u1ed5 sung apalutamide. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 d\u1eef li\u1ec7u ARCHES, apalutamide \u0111\u00e3 c\u1ea3i thi\u1ec7n c\u1ea3 hai \u0111i\u1ec3m cu\u1ed1i b\u1ea5t k\u1ec3 vi\u1ec7c \u0111\u00e3 t\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng docetaxel tr\u01b0\u1edbc \u0111\u00f3 hay ch\u01b0a ho\u1eb7c th\u1ec3 t\u00edch kh\u1ed1i u.<\/p>\n\n\n\n \u201cLi\u1ec7u ph\u00e1p ba thu\u1ed1c\u201d.<\/mark><\/strong>\u00a0G\u1ea7n \u0111\u00e2y h\u01a1n, s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa ADT v\u1edbi docetaxel v\u00e0 abiraterone acetate ho\u1eb7c darolutamide \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m nh\u01b0 m\u1ed9t ph\u1ea7n c\u1ee7a \u201cli\u1ec7u \u200b\u200bph\u00e1p ba thu\u1ed1c\u201d. Trong th\u1eed nghi\u1ec7m PEACE-1, nh\u1eefng ng\u01b0\u1eddi tham gia m\u1eafc mHSPC \u0111\u1ed3ng th\u1eddi \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n (SOC: ban \u0111\u1ea7u ch\u1ec9 d\u00f9ng ADT v\u00e0 sau \u0111\u00f3 chuy\u1ec3n sang ADT c\u1ed9ng v\u1edbi docetaxel) so v\u1edbi nh\u00f3m SOC c\u1ed9ng v\u1edbi abiraterone (d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi docetaxel) c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 x\u1ea1 tr\u1ecb v\u00f9ng kh\u1ed1i u nguy\u00ean ph\u00e1t (Fizazi et al., 2022). Trong s\u1ed1 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 nh\u1eadn ADT c\u1ed9ng v\u1edbi docetaxel nh\u01b0 SOC (N = 355 cho c\u1ea3 tr\u01b0\u1eddng h\u1ee3p c\u00f3 v\u00e0 kh\u00f4ng c\u00f3 abiraterone), vi\u1ec7c b\u1ed5 sung abiraterone \u0111\u00e3 c\u1ea3i thi\u1ec7n rPFS (HR = 0,50, 95% CI 0,34\u20130,71, p < 0,0001) v\u00e0 OS (HR = 0,75, 95% CI 0,59\u20130,95, p = 0,017). Cu\u1ed1i c\u00f9ng, trong th\u1eed nghi\u1ec7m ARASENS, 1306 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean \u0111\u1ec3 nh\u1eadn ADT c\u1ed9ng v\u1edbi docetaxel c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 darolutamide (600 mg\/hai l\u1ea7n m\u1ed7i ng\u00e0y \u0111\u1ed3ng th\u1eddi v\u1edbi docetaxel) trong b\u1ed1i c\u1ea3nh mHSPC (Smith et al., 2022). T\u1ea1i th\u1eddi \u0111i\u1ec3m b\u00e1o c\u00e1o, s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a ADT c\u1ed9ng v\u1edbi docetaxel v\u1edbi darolutamide c\u00f3 li\u00ean quan \u0111\u1ebfn c\u1ea3i thi\u1ec7n OS (HR 5 0,68; 95% CI 0,57\u20130,80, p < 0,001), c\u0169ng nh\u01b0 th\u1eddi gian \u0111\u1ebfn khi kh\u00e1ng l\u1ea1i li\u1ec7u ph\u00e1p c\u1eaft b\u1ecf tinh ho\u00e0n, ti\u1ebfn tri\u1ec3n \u0111au, c\u00e1c bi\u1ebfn c\u1ed1 v\u1ec1 x\u01b0\u01a1ng v\u00e0 li\u1ec7u ph\u00e1p ti\u1ebfp theo. Trong c\u1ea3 hai th\u1eed nghi\u1ec7m, PEACE-1 v\u00e0 ARASENS, h\u1ed3 s\u01a1 \u0111\u1ed9c t\u00ednh t\u01b0\u01a1ng t\u1ef1 nhau b\u1ea5t k\u1ec3 ph\u00e2n b\u1ed5 \u0111i\u1ec1u tr\u1ecb. T\u00f3m t\u1eaft c\u00e1c th\u1eed nghi\u1ec7m trong mHSPC c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong B\u1ea3ng 165.4.<\/p>\n\n\n\n \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 cho kh\u1ed1i u nguy\u00ean ph\u00e1t<\/strong>: <\/p>\n\n\n\n \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh di c\u0103n \u0111\u1ed3ng th\u1eddi, kh\u1ed1i u nguy\u00ean ph\u00e1t v\u1eabn kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n. V\u00ec \u0111\u00e2y l\u00e0 ngu\u1ed3n ti\u1ec1m t\u00e0ng cho s\u1ef1 ti\u1ebfn tri\u1ec3n di c\u0103n h\u01a1n n\u1eefa, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u1ed1i u nguy\u00ean ph\u00e1t \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong hai th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean. Trong th\u1eed nghi\u1ec7m HORRAD, 432 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT (ch\u1ec9 d\u00f9ng ch\u1ea5t ch\u1ee7 v\u1eadn LHRH) ho\u1eb7c nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT k\u1ebft h\u1ee3p x\u1ea1 tr\u1ecb tuy\u1ebfn ti\u1ec1n li\u1ec7t (Boev\u00e9 et al., 2019). Th\u1eddi gian s\u1ed1ng th\u00eam trung b\u00ecnh kh\u00f4ng kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c nh\u00f3m (HR = 0,9; 45 th\u00e1ng v\u1edbi ADT k\u1ebft h\u1ee3p x\u1ea1 tr\u1ecb so v\u1edbi 43 th\u00e1ng v\u1edbi ch\u1ec9 ADT), nh\u01b0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u1edf giai \u0111o\u1ea1n \u00edt (d\u01b0\u1edbi 5 v\u1ecb tr\u00ed), c\u00f3 d\u1ea5u hi\u1ec7u cho th\u1ea5y s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 th\u1eddi gian s\u1ed1ng th\u00eam t\u1ed5ng th\u1ec3 (HR = 0,68, 95% CI 0,42\u20131,10). Trong nh\u00e1nh H c\u1ee7a th\u1eed nghi\u1ec7m STAMPEDE, 2061 nam gi\u1edbi \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT \u0111\u01a1n thu\u1ea7n so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT k\u1ebft h\u1ee3p x\u1ea1 tr\u1ecb tuy\u1ebfn ti\u1ec1n li\u1ec7t v\u1edbi ph\u00e2n t\u00edch \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u01b0\u1edbc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u1edf giai \u0111o\u1ea1n \u00edt (Parker et al., 2018). M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t chung trong to\u00e0n b\u1ed9 nh\u00f3m b\u1ec7nh nh\u00e2n (HR 5 0,92, 95% CI 0,80\u20131,06), nh\u01b0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh di c\u0103n th\u1ec3 t\u00edch th\u1ea5p, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t chung \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n (HR 0,68, 95% CI 0,52\u20130,90) v\u1edbi 81% s\u1ed1ng s\u00f3t sau 3 n\u0103m khi b\u1ed5 sung x\u1ea1 tr\u1ecb so v\u1edbi 73% khi kh\u00f4ng c\u00f3 x\u1ea1 tr\u1ecb (Parker et al., 2018). \u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0, m\u1eb7c d\u00f9 c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t khi b\u1ed5 sung x\u1ea1 tr\u1ecb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n di c\u0103n th\u1ec3 t\u00edch th\u1ea5p, nh\u01b0ng nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y ch\u1ec9 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n. Vi\u1ec7c b\u1ed5 sung nh\u1eafm m\u1ee5c ti\u00eau AR, abiraterone ho\u1eb7c docetaxel kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean nh\u01b0 hi\u1ec7n nay \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n. Do \u0111\u00f3, gi\u00e1 tr\u1ecb c\u1ee7a vi\u1ec7c b\u1ed5 sung x\u1ea1 tr\u1ecb t\u1ea1i ch\u1ed7 khi xem x\u00e9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n k\u1ebft h\u1ee3p hi\u1ec7n ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. <\/p>\n\n\n\n C\u00e1c d\u1eef li\u1ec7u ng\u1eabu nhi\u00ean hi\u1ec7n c\u00f3 h\u1ed7 tr\u1ee3 vi\u1ec7c s\u1eed d\u1ee5ng x\u1ea1 tr\u1ecb tuy\u1ebfn ti\u1ec1n li\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n th\u1ec3 t\u00edch th\u1ea5p; tuy nhi\u00ean, vai tr\u00f2 c\u1ee7a ph\u1eabu thu\u1eadt v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng. M\u1ed9t ph\u00e2n t\u00edch \u0111a trung t\u00e2m tr\u00ean 113 b\u1ec7nh nh\u00e2n m\u1eafc ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n (mHSPC) \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn ti\u1ec1n li\u1ec7t gi\u1ea3m th\u1ec3 t\u00edch v\u00e0 \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n \u0111\u1ed3ng th\u1eddi cho th\u1ea5y t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t 5 n\u0103m l\u00e0 80% (Heidenreich et al., 2018). R\u1ee7i ro c\u1ee7a ph\u1eabu thu\u1eadt th\u1ea5p (10% theo ph\u00e2n lo\u1ea1i Clavien-Dindo \u0111\u1ed9 IIIa-b), v\u00e0 68% b\u1ec7nh nh\u00e2n v\u1eabn ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c ti\u1ec3u ti\u1ec7n khi theo d\u00f5i cu\u1ed1i c\u00f9ng. Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y cho th\u1ea5y ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn ti\u1ec1n li\u1ec7t gi\u1ea3m th\u1ec3 t\u00edch l\u00e0 kh\u1ea3 thi nh\u01b0ng n\u00ean \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n trong c\u00e1c ph\u00e1c \u0111\u1ed3 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ho\u1eb7c trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn ti\u1ec1n li\u1ec7t nh\u1eb1m gi\u1ea3m nh\u1eb9 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ea1i ch\u1ed7.<\/p>\n\n\n\n Li\u1ec7u ph\u00e1p nh\u1eafm m\u1ee5c ti\u00eau di c\u0103n<\/strong>: <\/p>\n\n\n\n V\u1edbi s\u1ef1 ra \u0111\u1eddi c\u1ee7a h\u00ecnh \u1ea3nh PET\/CT trong ch\u1ea9n \u0111o\u00e1n ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t t\u00e1i ph\u00e1t, ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh di c\u0103n th\u1ec3 t\u00edch r\u1ea5t th\u1ea5p, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 di c\u0103n \u00edt (#3 v\u1ecb tr\u00ed b\u1ec7nh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u00ean PET\/CT). V\u00ec ph\u1eabu thu\u1eadt x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u v\u00e0 x\u1ea1 tr\u1ecb \u0111\u1ecbnh v\u1ecb cho ph\u00e9p nh\u1eafm m\u1ee5c ti\u00eau v\u00e0o b\u1ec7nh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u00ean PET\/CT, \u0111i\u1ec1u tr\u1ecb t\u00e1i ph\u00e1t di c\u0103n \u00edt c\u00f3 th\u1ec3 mang l\u1ea1i m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c kh\u00f4ng d\u00f9ng hormone \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh. D\u1eef li\u1ec7u ban \u0111\u1ea7u v\u1ec1 t\u00e1i ph\u00e1t di c\u0103n \u00edt \u0111\u1ebfn t\u1eeb t\u00e1i ph\u00e1t h\u1ea1ch b\u1ea1ch huy\u1ebft. Trong m\u1ed9t ph\u00e2n t\u00edch \u0111a trung t\u00e2m quy m\u00f4 l\u1edbn g\u1ed3m 654 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf h\u1ea1ch b\u1ea1ch huy\u1ebft c\u1ee9u v\u00e3n \u0111\u1ed1i v\u1edbi t\u00e1i ph\u00e1t \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u00ean PET\/CT, v\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 30 th\u00e1ng, 49% b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb t\u00e1i ph\u00e1t l\u00e2m s\u00e0ng (Fossati et al., 2019). M\u1ed9t \u0111\u00e1nh gi\u00e1 h\u1ec7 th\u1ed1ng v\u00e0 ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p ti\u1ebfp theo v\u1ec1 ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf h\u1ea1ch b\u1ea1ch huy\u1ebft c\u1ee9u v\u00e3n cho th\u1ea5y t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t kh\u00f4ng t\u00e1i ph\u00e1t sinh h\u00f3a sau 5 n\u0103m ch\u1ec9 l\u00e0 31%; M\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m l\u00e0 84% (Ploussard et al., 2019). G\u1ea7n \u0111\u00e2y h\u01a1n, Bravi et al. (2020) \u0111\u00e3 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 c\u1ee7a 163 b\u1ec7nh nh\u00e2n v\u1edbi th\u1eddi gian theo d\u00f5i h\u01a1n 10 n\u0103m v\u00e0 b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t kh\u00f4ng t\u00e1i ph\u00e1t BCR sau 12 n\u0103m ch\u1ec9 l\u00e0 9%; m\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 10 n\u0103m v\u1eabn cao \u1edf m\u1ee9c 64%. G\u1ea7n \u0111\u00e2y h\u01a1n, hai th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean pha II \u0111\u00e3 \u0111\u01b0\u1ee3c ho\u00e0n th\u00e0nh trong l\u0129nh v\u1ef1c n\u00e0y b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng x\u1ea1 tr\u1ecb \u0111\u1ecbnh v\u1ecb. Th\u1eed nghi\u1ec7m STOMP \u0111\u00e3 ph\u00e2n ng\u1eabu nhi\u00ean 62 b\u1ec7nh nh\u00e2n c\u00f3 t\u00e1i ph\u00e1t nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean 11C choline (ba l\u1ea7n tr\u1edf xu\u1ed1ng) sau khi \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 tr\u01b0\u1edbc \u0111\u00f3 v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb (c\u1eaft b\u1ecf di c\u0103n b\u1eb1ng ph\u1eabu thu\u1eadt ho\u1eb7c x\u1ea1 tr\u1ecb) ho\u1eb7c nh\u00f3m theo d\u00f5i (Ost et al., 2018). \u0110i\u1ec3m cu\u1ed1i ch\u00ednh l\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t kh\u00f4ng c\u1ea7n ADT, v\u1edbi ADT \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u khi c\u00f3 ti\u1ebfn tri\u1ec3n tri\u1ec7u ch\u1ee9ng ho\u1eb7c b\u1ec7nh di c\u0103n ti\u1ebfn tri\u1ec3n (tr\u00ean h\u00ecnh \u1ea3nh). V\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 3 n\u0103m, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb ADT cao h\u01a1n \u1edf nh\u00f3m \u0111i\u1ec1u tr\u1ecb nh\u1eafm v\u00e0o di c\u0103n (MDT) (21 th\u00e1ng so v\u1edbi 13 th\u00e1ng), v\u1edbi 12 trong s\u1ed1 31 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n b\u1ea5t k\u1ef3 li\u1ec7u ph\u00e1p to\u00e0n th\u00e2n n\u00e0o t\u1ea1i th\u1eddi \u0111i\u1ec3m theo d\u00f5i cu\u1ed1i c\u00f9ng (Ost et al., 2018). Th\u1eed nghi\u1ec7m ORIOLE \u0111\u00e3 ph\u00e2n ng\u1eabu nhi\u00ean 54 b\u1ec7nh nh\u00e2n c\u00f3 t\u00e1i ph\u00e1t di c\u0103n \u00edt \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng PSMA PET\/CT v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng x\u1ea1 tr\u1ecb \u0111\u1ecbnh v\u1ecb ho\u1eb7c nh\u00f3m theo d\u00f5i v\u1edbi \u0111i\u1ec3m cu\u1ed1i ch\u00ednh l\u00e0 ti\u1ebfn tri\u1ec3n b\u1ec7nh trong 6 th\u00e1ng (sinh h\u00f3a ho\u1eb7c h\u00ecnh \u1ea3nh h\u1ecdc) (Phillips et al., 2020). T\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t kh\u00f4ng ti\u1ebfn tri\u1ec3n b\u1ec7nh \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n v\u1edbi 19% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng MDT ti\u1ebfn tri\u1ec3n b\u1ec7nh trong 6 th\u00e1ng so v\u1edbi 61% b\u1ec7nh nh\u00e2n (Phillips et al., 2020). Deek et al. (2022) \u0111\u00e3 th\u1ef1c hi\u1ec7n ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p b\u1ec7nh nh\u00e2n t\u1eeb c\u1ea3 hai nghi\u00ean c\u1ee9u STOMP v\u00e0 ORIOLES v\u00e0 k\u1ebft lu\u1eadn r\u1eb1ng MDT d\u1eabn \u0111\u1ebfn th\u1eddi gian s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n k\u00e9o d\u00e0i h\u01a1n (11,9 so v\u1edbi 5,9 th\u00e1ng, HR = 0,44; P < 0,001). Nh\u00ecn chung, nh\u1eefng d\u1eef li\u1ec7u n\u00e0y cho th\u1ea5y MDT c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n su\u1ed1t \u0111\u1eddi, nh\u01b0ng d\u1eef li\u1ec7u v\u1ec1 th\u1eddi gian s\u1ed1ng t\u1ed5ng th\u1ec3 c\u00f2n thi\u1ebfu v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng MDT n\u00ean \u0111\u01b0\u1ee3c d\u00e0nh cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9ng l\u1ef1c cao, nh\u1eefng ng\u01b0\u1eddi mong mu\u1ed1n tr\u00e1nh \u0111i\u1ec1u tr\u1ecb su\u1ed1t \u0111\u1eddi.<\/p>\n\n\n\n \u0110i\u1ec3m ch\u00ednh<\/strong><\/p>\n\n\n\n \u2022 Li\u1ec7u ph\u00e1p ADT k\u1ebft h\u1ee3p v\u1edbi docetaxel c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ec7nh nh\u00e2n m\u1eafc mHSPC, ch\u1ee7 y\u1ebfu l\u00e0 do b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ed1i u l\u1edbn. <\/p>\n\n\n\n \u2022 Li\u1ec7u ph\u00e1p ADT k\u1ebft h\u1ee3p v\u1edbi abiraterone, enzalutamide v\u00e0 apalutamide c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ec7nh nh\u00e2n m\u1eafc mHSPC b\u1ea5t k\u1ec3 kh\u1ed1i u v\u00e0 vi\u1ec7c \u0111\u00e3 s\u1eed d\u1ee5ng docetaxel tr\u01b0\u1edbc \u0111\u00f3 hay ch\u01b0a. <\/p>\n\n\n\n \u2022 Li\u1ec7u ph\u00e1p ADT k\u1ebft h\u1ee3p v\u1edbi docetaxel v\u00e0 abiraterone ho\u1eb7c darolutamide c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ec7nh nh\u00e2n m\u1eafc mHSPC; tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng “li\u1ec7u ph\u00e1p ba thu\u1ed1c” ch\u1ec9 n\u00ean d\u00e0nh cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u00f3a tr\u1ecb d\u1ef1a tr\u00ean ph\u01b0\u01a1ng ph\u00e1p ra quy\u1ebft \u0111\u1ecbnh chung, c\u00e2n nh\u1eafc gi\u1eefa kh\u1ed1i u (l\u1edbn so v\u1edbi nh\u1ecf; kh\u1ed1i u l\u1edbn c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng h\u01b0\u1edfng l\u1ee3i h\u01a1n t\u1eeb h\u00f3a tr\u1ecb), b\u1ec7nh \u0111\u1ed3ng th\u1eddi so v\u1edbi b\u1ec7nh kh\u00f4ng \u0111\u1ed3ng th\u1eddi (b\u1ec7nh \u0111\u1ed3ng th\u1eddi c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng h\u01b0\u1edfng l\u1ee3i h\u01a1n t\u1eeb h\u00f3a tr\u1ecb) v\u00e0 s\u1edf th\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n. <\/p>\n\n\n\n \u2022 \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 kh\u1ed1i u nguy\u00ean ph\u00e1t c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ec7nh nh\u00e2n mHSPC \u0111\u1ed3ng th\u1eddi c\u00f3 kh\u1ed1i u nh\u1ecf. <\/p>\n\n\n\n \u2022 Li\u1ec7u ph\u00e1p \u0111a thu\u1ed1c (MDT) c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng s\u00f3t kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 \u00edt di c\u0103n.<\/p>\n\n\n\n THEO D\u00d5I TRONG QU\u00c1 TR\u00ccNH \u0110I\u1ec0U TR\u1eca UNG TH\u01af TUY\u1ebeN TI\u1ec0N LI\u1ec6T DI C\u0102N NH\u1ea0Y C\u1ea2M V\u1edaI HORMONE<\/mark><\/strong> <\/p>\n\n\n\n \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n su\u1ed1t \u0111\u1eddi, c\u1ea7n theo d\u00f5i th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 ki\u1ec3m so\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng do \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. H\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh v\u1ec1 Ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a AUA, H\u01b0\u1edbng d\u1eabn theo d\u00f5i Ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t c\u1ee7a EAU v\u00e0 H\u01b0\u1edbng d\u1eabn v\u1ec1 Ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t c\u1ee7a NCCN khuy\u1ebfn c\u00e1o theo d\u00f5i 3 \u0111\u1ebfn 6 th\u00e1ng m\u1ed9t l\u1ea7n v\u00e0 n\u00ean bao g\u1ed3m theo d\u00f5i PSA ngo\u00e0i b\u1ea5t k\u1ef3 th\u00f4ng s\u1ed1 huy\u1ebft thanh n\u00e0o c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi \u0111i\u1ec1u tr\u1ecb (x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan, h\u1ed3 s\u01a1 huy\u1ebft h\u1ecdc, v.v.) (Lowrance et al., 2023; Schaeffer et al., 2022; Cornford et al., 2021). C\u1ea7n ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 testosterone khi PSA t\u0103ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o duy tr\u00ec m\u1ee9c testosterone \u1edf m\u1ee9c thi\u1ebfn, v\u00ec PSA t\u0103ng trong b\u1ed1i c\u1ea3nh testosterone \u1edf m\u1ee9c thi\u1ebfn x\u00e1c \u0111\u1ecbnh b\u1ec7nh kh\u00e1ng thi\u1ebfn. Ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh n\u1ebfu c\u00f3 k\u1ebf ho\u1ea1ch thay \u0111\u1ed5i ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ho\u1eb7c n\u1ebfu nghi ng\u1edd b\u1ec7nh ti\u1ebfn tri\u1ec3n th\u00e0nh b\u1ec7nh kh\u00e1ng thi\u1ebfn. Ngo\u00e0i ra, c\u0169ng nh\u01b0 v\u1edbi li\u1ec7u ph\u00e1p ADT cho BCR, c\u1ea7n ch\u00fa \u00fd \u0111\u1ea3m b\u1ea3o s\u1ee9c kh\u1ecfe x\u01b0\u01a1ng \u0111\u1ea7y \u0111\u1ee7 (ki\u1ec3m tra lo\u00e3ng x\u01b0\u01a1ng b\u1eb1ng \u0111o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng b\u1eb1ng tia X n\u0103ng l\u01b0\u1ee3ng k\u00e9p DEXA scan ban \u0111\u1ea7u v\u00e0 \u0111\u1ecbnh k\u1ef3), t\u1ed1i \u01b0u h\u00f3a s\u1ee9c kh\u1ecfe tim m\u1ea1ch.<\/p>\n\n\n\n M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a vi\u1ec7c theo d\u00f5i b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p hormone (ADT) l\u00e0 \u0111\u1ea3m b\u1ea3o tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed l\u00fd s\u1edbm c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5, v\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb khi b\u1ec7nh ti\u1ebfn tri\u1ec3n.<\/p>\n\n\n\n Sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT, khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ecbnh k\u1ef3 3 \u0111\u1ebfn 6 th\u00e1ng m\u1ed9t l\u1ea7n. Vi\u1ec7c n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a, v\u00e0 m\u1ed7i b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c khuy\u00ean li\u00ean h\u1ec7 v\u1edbi b\u00e1c s\u0129 n\u1ebfu g\u1eb7p c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f3 ch\u1ecbu. \u0110i\u1ec1u n\u00e0y c\u00e0ng quan tr\u1ecdng h\u01a1n \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ADT v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c m\u1ea1nh kh\u00e1c, v\u00ed d\u1ee5 nh\u01b0 ARPI, trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y t\u1ea7n su\u1ea5t theo d\u00f5i l\u00e0 h\u00e0ng th\u00e1ng trong ba th\u00e1ng \u0111\u1ea7u ti\u00ean.<\/p>\n\n\n\n Theo d\u00f5i t\u1ed5ng qu\u00e1t nam gi\u1edbi \u0111ang \u0111i\u1ec1u tr\u1ecb hormone<\/em><\/strong><\/p>\n\n\n\n B\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i th\u01b0\u1eddng xuy\u00ean, bao g\u1ed3m theo d\u00f5i n\u1ed3ng \u0111\u1ed9 testosterone huy\u1ebft thanh, creatinine, ch\u1ee9c n\u0103ng gan v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 chuy\u1ec3n h\u00f3a trong kho\u1ea3ng th\u1eddi gian ba \u0111\u1ebfn s\u00e1u th\u00e1ng. Nam gi\u1edbi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u1ed9c h\u1ea1i b\u1ea5t k\u1ec3 giai \u0111o\u1ea1n b\u1ec7nh c\u1ee7a h\u1ecd. Li\u1ec7u ph\u00e1p gi\u1ea3m androgen g\u00e2y m\u1ea5t m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng l\u00e0m t\u0103ng nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng [1452]. Do \u0111\u00f3, vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng tr\u01b0\u1edbc v\u00e0 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft.<\/p>\n\n\n\n V\u00ec h\u1eadu qu\u1ea3 c\u1ee7a ADT r\u1ea5t kh\u00e1c nhau, vi\u1ec7c theo d\u00f5i c\u00f3 c\u1ea5u tr\u00fac bao g\u1ed3m k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m, ch\u1ee5p X-quang v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u00f3 th\u1ec3 c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ed1i v\u1edbi c\u1ea3 b\u1ec7nh nh\u00e2n v\u00e0 b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb [1453].<\/p>\n\n\n\n Theo d\u00f5i testosterone<\/em><\/p>\n\n\n\n Vi\u1ec7c theo d\u00f5i testosterone n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ti\u00eau chu\u1ea9n \u1edf nam gi\u1edbi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT. Nhi\u1ec1u nam gi\u1edbi \u0111\u01b0\u1ee3c thi\u1ebfn b\u1eb1ng thu\u1ed1c s\u1ebd \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c testosterone sau thi\u1ebfn (< 20 ng\/dL), v\u00e0 h\u1ea7u h\u1ebft s\u1ebd \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c testosterone (< 50 ng\/dL). Tuy nhi\u00ean, kho\u1ea3ng 13\u201338% b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c n\u00e0y, v\u00e0 c\u00f3 t\u1edbi 24% nam gi\u1edbi c\u00f3 th\u1ec3 tr\u1ea3i qua s\u1ef1 t\u0103ng \u0111\u1ed9t bi\u1ebfn testosterone t\u1ea1m th\u1eddi (testosterone > 50 ng\/dL) trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i [1438] – m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u2018hi\u1ec7u \u1ee9ng c\u1ea5p t\u00ednh tr\u00ean n\u1ec1n m\u1ea1n t\u00ednh\u2019 ho\u1eb7c \u2018ph\u1ea3n \u1ee9ng \u0111\u1ed9t ph\u00e1\u2019 [1454]. T\u1ef7 l\u1ec7 \u0111\u1ed9t ph\u00e1 \u0111\u1ed1i v\u1edbi ng\u01b0\u1ee1ng < 20 ng\/dL \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n th\u01b0\u1eddng xuy\u00ean h\u01a1n (41,3%) v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng x\u1ea5u h\u01a1n [1454].<\/p>\n\n\n\n Th\u1eddi \u0111i\u1ec3m \u0111o l\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ee9c testosterone t\u1eeb ba \u0111\u1ebfn s\u00e1u th\u00e1ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 duy tr\u00ec vi\u1ec7c thi\u1ebfn (\u0111\u1eb7c bi\u1ec7t l\u00e0 trong qu\u00e1 tr\u00ecnh thi\u1ebfn b\u1eb1ng thu\u1ed1c). N\u1ebfu kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c testosterone sau khi thi\u1ebfn, n\u00ean xem x\u00e9t chuy\u1ec3n sang ch\u1ea5t ch\u1ee7 v\u1eadn ho\u1eb7c ch\u1ea5t \u0111\u1ed1i kh\u00e1ng kh\u00e1c ho\u1eb7c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tinh ho\u00e0n. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 PSA t\u0103ng \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn v\u00e0\/ho\u1eb7c ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng, c\u1ea7n ph\u1ea3i \u0111\u00e1nh gi\u00e1 n\u1ed3ng \u0111\u1ed9 testosterone huy\u1ebft thanh trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec3 x\u00e1c nh\u1eadn t\u00ecnh tr\u1ea1ng kh\u00e1ng l\u1ea1i vi\u1ec7c thi\u1ebfn. M\u1ee9c testosterone sau khi thi\u1ebfn kh\u00f4ng t\u1ed1i \u01b0u l\u00fd t\u01b0\u1edfng nh\u1ea5t n\u00ean \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng x\u00e9t nghi\u1ec7m th\u00edch h\u1ee3p [1455,1456]. Sau khi ng\u1eebng ADT (\u0111i\u1ec1u tr\u1ecb gi\u00e1n \u0111o\u1ea1n ho\u1eb7c s\u1eed d\u1ee5ng ADT t\u1ea1m th\u1eddi nh\u01b0 v\u1edbi EBRT), s\u1ef1 ph\u1ee5c h\u1ed3i testosterone ph\u1ee5 thu\u1ed9c v\u00e0o tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n, m\u1ee9c testosterone tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u ADT v\u00e0 h\u00ecnh th\u1ee9c c\u0169ng nh\u01b0 th\u1eddi gian c\u1ee7a ADT [1457,1458].<\/p>\n\n\n\n Theo d\u00f5i ch\u1ee9c n\u0103ng gan<\/em><\/p>\n\n\n\n C\u00e1c x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan s\u1ebd ph\u00e1t hi\u1ec7n \u0111\u1ed9c t\u00ednh c\u1ee7a \u0111i\u1ec1u tr\u1ecb, \u0111i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t \u00e1p d\u1ee5ng cho NSAA abiraterone acetate v\u00e0 c\u00e1c ch\u1ea5t \u0111\u1ed1i kh\u00e1ng AR m\u1edbi. C\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y hi\u1ebfm khi cho th\u1ea5y s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh nh\u01b0ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 theo d\u00f5i c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5. N\u1ed3ng \u0111\u1ed9 men gan n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra \u00edt nh\u1ea5t m\u1ed9t l\u1ea7n m\u1ed7i n\u0103m \u1edf t\u1ea5t c\u1ea3 nam gi\u1edbi \u0111ang \u0111i\u1ec1u tr\u1ecb ADT k\u1ebft h\u1ee3p. Tuy nhi\u00ean, c\u1ea7n theo d\u00f5i th\u01b0\u1eddng xuy\u00ean h\u01a1n trong s\u00e1u th\u00e1ng \u0111\u1ea7u ti\u00ean sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, v\u00ec c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 ch\u1ee9c n\u0103ng gan th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y trong giai \u0111o\u1ea1n n\u00e0y trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng quy m\u00f4 l\u1edbn [1459]. T\u1ea7n su\u1ea5t theo d\u00f5i c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o lo\u1ea1i thu\u1ed1c c\u1ee5 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, v\u1edbi vi\u1ec7c theo d\u00f5i chuy\u00ean s\u00e2u h\u01a1n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ed1i v\u1edbi c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 c\u00f3 ti\u1ec1m n\u0103ng g\u00e2y \u0111\u1ed9c cho gan cao h\u01a1n, ch\u1eb3ng h\u1ea1n nh\u01b0 abiraterone acetate [1460].<\/p>\n\n\n\n Creatinin huy\u1ebft thanh v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 huy\u1ebft h\u1ecdc<\/em><\/p>\n\n\n\n Theo d\u00f5i t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn \u01b0\u1edbc t\u00ednh l\u00e0 m\u1ed9t th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng t\u1ed1t v\u00ec s\u1ef1 gia t\u0103ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u1eafc ngh\u1ebdn ni\u1ec7u qu\u1ea3n ho\u1eb7c b\u00ed ti\u1ec3u. S\u1ef1 suy gi\u1ea3m hemoglobin l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u00e3 bi\u1ebft c\u1ee7a ADT. S\u1ef1 suy gi\u1ea3m \u0111\u00e1ng k\u1ec3 sau ba th\u00e1ng \u0111i\u1ec1u tr\u1ecb ADT c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp v\u1edbi t\u1ef7 l\u1ec7 s\u1ed1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng t\u1ed5ng th\u1ec3 ng\u1eafn h\u01a1n v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch t\u00ecnh tr\u1ea1ng m\u1ec7t m\u1ecfi \u0111\u00e1ng k\u1ec3, m\u1eb7c d\u00f9 c\u1ea7n xem x\u00e9t c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c [1461]. Thi\u1ebfu m\u00e1u th\u01b0\u1eddng do nhi\u1ec1u y\u1ebfu t\u1ed1 v\u00e0 c\u1ea7n lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 kh\u00e1c. S\u1ef1 gi\u1ea3m s\u1edbm hemoglobin ba th\u00e1ng sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ADT d\u1ef1 \u0111o\u00e1n kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t t\u1ed1t h\u01a1n, trong khi s\u1ef1 gi\u1ea3m sau s\u00e1u th\u00e1ng c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 k\u00e9m trong qu\u1ea7n th\u1ec3 SPCG-5 [1462].<\/p>\n\n\n\n Theo d\u00f5i c\u00e1c bi\u1ebfn ch\u1ee9ng chuy\u1ec3n h\u00f3a<\/em><\/p>\n\n\n\n C\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u1ea5t c\u1ee7a vi\u1ec7c \u1ee9c ch\u1ebf androgen l\u00e0 h\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a, b\u1ec7nh tim m\u1ea1ch, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 ti\u00eau x\u01b0\u01a1ng (xem Ph\u1ea7n 8.2.5).<\/p>\n\n\n\n T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng b\u1eb1ng c\u00e1ch ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i v\u00e0 HbA1c (l\u00fac ban \u0111\u1ea7u v\u00e0 \u0111\u1ecbnh k\u1ef3) ngo\u00e0i vi\u1ec7c ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 lipid m\u00e1u. Nam gi\u1edbi b\u1ecb r\u1ed1i lo\u1ea1n dung n\u1ea1p glucose v\u00e0\/ho\u1eb7c ti\u1ec3u \u0111\u01b0\u1eddng n\u00ean \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ebfn b\u00e1c s\u0129 n\u1ed9i ti\u1ebft \u0111\u1ec3 t\u01b0 v\u1ea5n. Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf androgen (ADT), c\u1ea7n th\u1ef1c hi\u1ec7n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 (ECG). N\u00ean tham kh\u1ea3o \u00fd ki\u1ebfn \u200b\u200bb\u00e1c s\u0129 tim m\u1ea1ch, \u00edt nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi nam gi\u1edbi c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch, v\u00e0 t\u00f9y thu\u1ed9c v\u00e0o lo\u1ea1i thu\u1ed1c k\u1ebft h\u1ee3p d\u1ef1 ki\u1ebfn, c\u0169ng n\u00ean si\u00eau \u00e2m tim (ECHO). Nam gi\u1edbi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u00f3 nguy c\u01a1 cao b\u1ecb t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 tim m\u1ea1ch; do \u0111\u00f3, c\u1ea7n ki\u1ec3m tra th\u01b0\u1eddng xuy\u00ean [1463]. Vi\u1ec7c lo\u1ea1i b\u1ecf androgen s\u00e2u h\u01a1n d\u1eabn \u0111\u1ebfn \u0111\u1ed9c t\u00ednh tim m\u1ea1ch cao h\u01a1n [1464] v\u00e0 th\u1ec3 l\u1ef1c h\u00f4 h\u1ea5p tim m\u1ea1ch gi\u1ea3m ngay c\u1ea3 sau s\u00e1u th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT [1465].<\/p>\n\n\n\n Theo d\u00f5i c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 x\u01b0\u01a1ng<\/em><\/p>\n\n\n\n Li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf androgen l\u00e0m t\u0103ng nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng. S\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa ADT v\u1edbi apalutamide, darolutamide, enzalutamide, abiraterone c\u1ed9ng v\u1edbi prednisone ho\u1eb7c docetaxel l\u00e0m t\u0103ng nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng h\u01a1n n\u1eefa [1245,1466,1467]. Vi\u1ec7c s\u1eed d\u1ee5ng ADT trong h\u01a1n m\u1ed9t n\u0103m, so v\u1edbi d\u01b0\u1edbi m\u1ed9t n\u0103m, cho th\u1ea5y nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng cao h\u01a1n (HR: 1,77 v\u00e0 1,38, t\u01b0\u01a1ng \u1ee9ng) [1468]. M\u1ed9t s\u1ed1 thang \u0111i\u1ec3m (v\u00ed d\u1ee5: C\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng [\u0111i\u1ec3m FRAX], C\u00f4ng c\u1ee5 t\u1ef1 \u0111\u00e1nh gi\u00e1 lo\u00e3ng x\u01b0\u01a1ng [OST], C\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng [ORAI], Ch\u1ec9 s\u1ed1 nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng [OSIRIS] v\u00e0 \u01af\u1edbc t\u00ednh nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng [SCORE]) c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh nam gi\u1edbi c\u00f3 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng lo\u00e3ng x\u01b0\u01a1ng, nh\u01b0ng c\u1ea7n ph\u1ea3i x\u00e1c th\u1ef1c c\u00e1c thang \u0111i\u1ec3m n\u00e0y trong b\u1ed1i c\u1ea3nh \u0111i\u1ec1u tr\u1ecb ADT (xem Ph\u1ea7n 8.3.2.b) [1348,1469,1470].<\/p>\n\n\n\n N\u1ed3ng \u0111\u1ed9 vitamin D v\u00e0 canxi n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i th\u01b0\u1eddng xuy\u00ean khi b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb ADT, v\u00e0 n\u00ean b\u1ed5 sung n\u1ebfu c\u1ea7n (xem Ph\u1ea7n 8.3.2.b).<\/p>\n\n\n\n Vi\u1ec7c theo d\u00f5i x\u01b0\u01a1ng \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 ph\u00e1t hi\u1ec7n lo\u00e3ng x\u01b0\u01a1ng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ADT b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p \u0111o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng b\u1eb1ng tia X ph\u00e1t x\u1ea1 k\u00e9p (DEXA) [1349,1471,1472]. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a lo\u00e3ng x\u01b0\u01a1ng s\u1ebd th\u00fac \u0111\u1ea9y vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t b\u1ea3o v\u1ec7 x\u01b0\u01a1ng. C\u00e1c ti\u00eau ch\u00ed \u0111\u1ec3 b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng thu\u1ed1c b\u1ea3o v\u1ec7 x\u01b0\u01a1ng \u0111\u01b0\u1ee3c n\u00eau trong M\u1ee5c 8.3.2.b. N\u1ebfu kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c b\u1ea3o v\u1ec7 x\u01b0\u01a1ng, c\u1ea7n th\u1ef1c hi\u1ec7n qu\u00e9t DEXA th\u01b0\u1eddng xuy\u00ean – \u00edt nh\u1ea5t hai n\u0103m m\u1ed9t l\u1ea7n [1473].<\/p>\n\n\n\n M\u1ed9t \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p v\u1ec1 t\u1ef7 l\u1ec7 g\u00e3y x\u01b0\u01a1ng cho th\u1ea5y nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng t\u0103ng g\u1ea7n g\u1ea5p \u0111\u00f4i khi s\u1eed d\u1ee5ng ADT t\u00f9y thu\u1ed9c v\u00e0o tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n, th\u1eddi gian v\u00e0 lo\u1ea1i ADT, v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc cao nh\u1ea5t \u1edf nam gi\u1edbi l\u1edbn tu\u1ed5i v\u00e0 nam gi\u1edbi s\u1eed d\u1ee5ng th\u00eam thu\u1ed1c ARPI m\u1edbi tr\u00ean to\u00e0n b\u1ed9 ph\u1ed5 b\u1ec7nh [1474]. Trong tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng do lo\u00e3ng x\u01b0\u01a1ng, vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c b\u1ea3o v\u1ec7 x\u01b0\u01a1ng l\u00e0 b\u1eaft bu\u1ed9c.<\/p>\n\n\n\n Theo d\u00f5i l\u1ed1i s\u1ed1ng, s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n, nh\u1eadn th\u1ee9c, m\u1ec7t m\u1ecfi v\u00e0 ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c<\/em><\/p>\n\n\n\n L\u1ed1i s\u1ed1ng (v\u00ed d\u1ee5: ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, t\u1eadp th\u1ec3 d\u1ee5c, t\u00ecnh tr\u1ea1ng h\u00fat thu\u1ed1c, v.v.) \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 c\u00f3 th\u1ec3 c\u1ea3 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb [1475]. Trong qu\u00e1 tr\u00ecnh theo d\u00f5i, nam gi\u1edbi n\u00ean \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n v\u1ec1 nh\u1eefng l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c t\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ec3 gi\u1ea3m \u0111\u1ed9c t\u00ednh li\u00ean quan \u0111\u1ebfn ADT [1476]. Li\u1ec7u ph\u00e1p gi\u1ea3m androgen c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 nh\u1eadn th\u1ee9c, v\u00e0 nam gi\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u00f3 nguy c\u01a1 b\u1ecb tr\u1ea7m c\u1ea3m cao g\u1ea5p ba l\u1ea7n [1477]. Do \u0111\u00f3, vi\u1ec7c ch\u00fa tr\u1ecdng \u0111\u1ebfn s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n n\u00ean l\u00e0 m\u1ed9t ph\u1ea7n kh\u00f4ng th\u1ec3 thi\u1ebfu trong k\u1ebf ho\u1ea1ch theo d\u00f5i. Nam gi\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i c\u00e1c tri\u1ec7u ch\u1ee9ng m\u1ec7t m\u1ecfi, c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn vi\u00eam to\u00e0n th\u00e2n [1478]. Gi\u1ea3m hi\u1ec7u su\u1ea5t nh\u1eadn th\u1ee9c v\u00e0 m\u1ec7t m\u1ecfi c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong v\u00f2ng s\u00e1u th\u00e1ng sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT nh\u01b0ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n theo th\u1eddi gian [1479]. M\u1ed9t kh\u00eda c\u1ea1nh kh\u00e1c c\u1ee7a vi\u1ec7c b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT l\u00e0 n\u00f3 d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, khi\u1ebfn h\u01a1n 80% c\u00e1c c\u1eb7p \u0111\u00f4i ng\u1eebng ho\u00e0n to\u00e0n ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c. Kh\u00eda c\u1ea1nh n\u00e0y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea3 b\u1ec7nh nh\u00e2n v\u00e0 b\u1ea1n \u0111\u1eddi c\u1ee7a h\u1ecd, v\u00e0 n\u00ean xem x\u00e9t t\u01b0 v\u1ea5n cho c\u1ea3 hai ng\u01b0\u1eddi [1480].<\/p>\n\n\n\n Theo d\u00f5i PSA<\/em><\/p>\n\n\n\n \u1ede nam gi\u1edbi ch\u1ec9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT, vi\u1ec7c gi\u1ea3m PSA xu\u1ed1ng < 2,4 ng\/mL cho th\u1ea5y kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng k\u00e9o d\u00e0i v\u00e0 c\u00f3 th\u1ec3 l\u00ean l\u1ecbch kh\u00e1m theo d\u00f5i m\u1ed7i ba \u0111\u1ebfn s\u00e1u th\u00e1ng, v\u1edbi \u0111i\u1ec1u ki\u1ec7n b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. \u0110i\u1ec1u n\u00e0y \u00e1p d\u1ee5ng cho nam gi\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT \u0111\u01a1n thu\u1ea7n c\u0169ng nh\u01b0 sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT k\u1ebft h\u1ee3p v\u1edbi docetaxel [1219]. T\u00f9y thu\u1ed9c v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111\u00e1nh gi\u00e1 r\u1ee7i ro, c\u00f3 th\u1ec3 c\u1ea7n kh\u00e1m th\u01b0\u1eddng xuy\u00ean h\u01a1n. \u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 PSA trong huy\u1ebft thanh [1218,1219] v\u00e0 ch\u1ee5p x\u01b0\u01a1ng v\u00e0 CT, m\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn v\u1ec1 t\u1ea7n su\u1ea5t th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y [1414]. S\u1ef1 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 PSA th\u01b0\u1eddng x\u1ea3y ra tr\u01b0\u1edbc khi xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0i th\u00e1ng. PSA t\u0103ng cao c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 n\u1ed3ng \u0111\u1ed9 testosterone, \u0111i\u1ec1u n\u00e0y l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng CRPC, c\u0169ng nh\u01b0 t\u00e1i ph\u00e2n giai \u0111o\u1ea1n b\u1eb1ng h\u00ecnh \u1ea3nh. Tuy nhi\u00ean, hi\u1ec7n nay ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y r\u1eb1ng PSA \u1ed5n \u0111\u1ecbnh trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT l\u00e0 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng kh\u00f4ng ti\u1ebfn tri\u1ec3n [1482]. Ngo\u00e0i ra, trong qu\u00e1 tr\u00ecnh k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb ADT v\u00e0 ARPI, vi\u1ec7c ch\u1ec9 d\u1ef1a v\u00e0o PSA m\u00e0 kh\u00f4ng ch\u1ee5p \u1ea3nh th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 b\u1ecf s\u00f3t vi\u1ec7c ph\u00e1t hi\u1ec7n s\u1edbm PCa ti\u1ebfn tri\u1ec3n v\u00ec m\u1ed9t ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p c\u1ee7a nghi\u00ean c\u1ee9u Titan cho th\u1ea5y g\u1ea7n m\u1ed9t n\u1eeda s\u1ed1 b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n ti\u1ebfn tri\u1ec3n tr\u00ean h\u00ecnh \u1ea3nh ch\u1ee5p X-quang sau \u0111\u00f3 kh\u00f4ng c\u00f3 PSA \u0111\u1ed3ng th\u1eddi [1246].<\/p>\n\n\n\n Ch\u1ee5p \u1ea3nh ch\u1ea9n \u0111o\u00e1n nh\u01b0 m\u1ed9t ch\u1ec9 d\u1ea5u \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb trong ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n<\/em><\/p>\n\n\n\n \u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb trong di c\u0103n m\u00f4 m\u1ec1m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ee5p \u1ea3nh h\u00ecnh th\u00e1i s\u1eed d\u1ee5ng ti\u00eau ch\u00ed \u0110\u00e1nh gi\u00e1 \u0110\u00e1p \u1ee9ng trong Kh\u1ed1i u r\u1eafn (RECIST). Tuy nhi\u00ean, c\u00e1c ti\u00eau ch\u00ed n\u00e0y kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho di c\u0103n x\u01b0\u01a1ng v\u00ec vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng r\u1ea5t kh\u00f3 kh\u0103n [1483,1484].<\/p>\n\n\n\n \u01af\u1edbc t\u00ednh \u0111\u1ecbnh l\u01b0\u1ee3ng v\u1ec1 s\u1ef1 h\u1ea5p th\u1ee5 ch\u1ea5t \u0111\u00e1nh d\u1ea5u tr\u00ean \u1ea3nh ch\u1ee5p x\u1ea1 h\u00ecnh x\u01b0\u01a1ng c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c th\u00f4ng qua c\u00e1c ph\u01b0\u01a1ng ph\u00e1p t\u1ef1 \u0111\u1ed9ng nh\u01b0 Ch\u1ec9 s\u1ed1 Ch\u1ee5p X\u1ea1 H\u00ecnh X\u01b0\u01a1ng [1485]. Tuy nhi\u00ean, ch\u1ee5p x\u1ea1 h\u00ecnh x\u01b0\u01a1ng g\u1eb7p kh\u00f3 kh\u0103n do hi\u1ec7n t\u01b0\u1ee3ng g\u1ecdi l\u00e0 “b\u00f9ng ph\u00e1t”, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 b\u1ed9c l\u1ed9 c\u00e1c di c\u0103n tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c do \u0111i\u1ec1u tr\u1ecb g\u00e2y ra. Hi\u1ec7n t\u01b0\u1ee3ng “b\u00f9ng ph\u00e1t” n\u00e0y th\u1ef1c s\u1ef1 th\u1ec3 hi\u1ec7n m\u1ed9t \u0111\u00e1p \u1ee9ng thu\u1eadn l\u1ee3i khi \u0111\u01b0\u1ee3c quan s\u00e1t trong v\u00f2ng t\u00e1m \u0111\u1ebfn m\u01b0\u1eddi hai tu\u1ea7n k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. Vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a di c\u0103n x\u01b0\u01a1ng v\u00e0 hi\u1ec7n t\u01b0\u1ee3ng “b\u00f9ng ph\u00e1t” n\u00e0y \u0111\u00f2i h\u1ecfi ph\u1ea3i ch\u1ee5p x\u1ea1 h\u00ecnh x\u01b0\u01a1ng nhi\u1ec1u l\u1ea7n. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i c\u00e1c t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng x\u01a1 c\u1ee9ng v\u00ec x\u01a1 c\u1ee9ng x\u01b0\u01a1ng c\u00f3 th\u1ec3 x\u1ea3y ra ngay c\u1ea3 khi \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 ph\u1ea3n \u00e1nh qu\u00e1 tr\u00ecnh l\u00e0nh x\u01b0\u01a1ng. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 tr\u1ef1c ti\u1ebfp t\u1ee7y x\u01b0\u01a1ng v\u00e0 ch\u1ee9ng minh s\u1ef1 ti\u1ebfn tri\u1ec3n d\u1ef1a tr\u00ean c\u00e1c ti\u00eau ch\u00ed h\u00ecnh th\u00e1i ho\u1eb7c thay \u0111\u1ed5i h\u1ec7 s\u1ed1 khu\u1ebfch t\u00e1n bi\u1ec3u ki\u1ebfn. C\u00f3 s\u1eb5n ti\u00eau chu\u1ea9n b\u00e1o c\u00e1o [1486]. Kh\u1ea3 n\u0103ng \u0111\u00e1nh gi\u00e1 ph\u1ea3n \u1ee9ng c\u1ee7a PET\/CT \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u. Cho \u0111\u1ebfn khi c\u00f3 th\u00eam d\u1eef li\u1ec7u, MRI v\u00e0 PET\/CT kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng b\u00ean ngo\u00e0i c\u00e1c th\u1eed nghi\u1ec7m \u0111\u1ec3 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n di c\u0103n [1487].<\/p>\n\n\n\n Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 s\u1ef1 t\u0103ng PSA, nam gi\u1edbi m\u1eafc ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ADT c\u0169ng n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i b\u1eb1ng h\u00ecnh \u1ea3nh th\u01b0\u1eddng xuy\u00ean, v\u00ec 25% nam gi\u1edbi c\u00f3 ho\u1eb7c kh\u00f4ng d\u00f9ng docetaxel trong th\u1eed nghi\u1ec7m CHAARTED \u0111\u00e3 ph\u00e1t tri\u1ec3n b\u1ec7nh ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 t\u0103ng PSA [1482]. M\u1ed9t trong t\u00e1m nam gi\u1edbi c\u00f3 PSA < 2ng\/mL cho th\u1ea5y b\u1ec7nh ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng [1482]. Vi\u1ec7c b\u1ed5 sung docetaxel v\u00e0o ADT trong qu\u1ea7n th\u1ec3 th\u1eed nghi\u1ec7m CHAARTED kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng \u1edf m\u1ee9c PSA th\u1ea5p v\u00e0 t\u1ef7 l\u1ec7 n\u00e0y t\u01b0\u01a1ng t\u1ef1 \u0111\u1ed1i v\u1edbi c\u1ea3 b\u1ec7nh c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng th\u1ea5p v\u00e0 cao theo ti\u00eau ch\u00ed CHAARTED [1482]. Ngo\u00e0i ra, trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ADT v\u00e0 ARPI \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n (mHSPC), vi\u1ec7c ch\u1ec9 d\u1ef1a v\u00e0o PSA m\u00e0 kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 b\u1ecf s\u00f3t vi\u1ec7c ph\u00e1t hi\u1ec7n s\u1edbm ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t ti\u1ebfn tri\u1ec3n v\u00ec m\u1ed9t ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p c\u1ee7a nghi\u00ean c\u1ee9u Titan cho th\u1ea5y g\u1ea7n m\u1ed9t n\u1eeda s\u1ed1 b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n b\u1ec7nh ti\u1ebfn tri\u1ec3n tr\u00ean h\u00ecnh \u1ea3nh ch\u1ee5p X-quang sau \u0111\u00f3 kh\u00f4ng c\u00f3 s\u1ef1 ti\u1ebfn tri\u1ec3n PSA \u0111\u1ed3ng th\u1eddi [1246]. Trong nghi\u00ean c\u1ee9u Prevail, g\u1ea7n m\u1ed9t ph\u1ea7n t\u01b0 b\u1ec7nh nh\u00e2n mCRPC d\u00f9ng enzalutamide c\u00f3 ti\u1ebfn tri\u1ec3n tr\u00ean h\u00ecnh \u1ea3nh ch\u1ee5p X-quang m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 gia t\u0103ng PSA [1488]. Tuy nhi\u00ean, th\u1eddi \u0111i\u1ec3m t\u1ed1i \u01b0u v\u00e0 ph\u01b0\u01a1ng th\u1ee9c h\u00ecnh \u1ea3nh c\u1ea7n s\u1eed d\u1ee5ng v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng, c\u0169ng nh\u01b0 gi\u00e1 tr\u1ecb l\u00e2m s\u00e0ng th\u1ef1c s\u1ef1 c\u1ee7a b\u1ea5t k\u1ef3 ph\u00e1t hi\u1ec7n n\u00e0o.<\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" Ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t di c\u0103n c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u (kh\u00f4ng \u0111\u1ed3ng th\u1eddi) \u0111\u1ed1i v\u1edbi b\u1ec7nh khu tr\u00fa ho\u1eb7c c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ngay t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n (\u0111\u1ed3ng th\u1eddi). \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh di c\u0103n, c\u00f3 nhi\u1ec1u ph\u00e2n lo\u1ea1i kh\u00e1c nhau \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o qu\u1ea3n […]<\/p>\n","protected":false},"author":1,"featured_media":493,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"pagelayer_contact_templates":[],"_pagelayer_content":"","footnotes":""},"categories":[22],"tags":[],"class_list":["post-487","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-loi-khuyen-tu-chuyen-gia"],"_links":{"self":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts\/487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/comments?post=487"}],"version-history":[{"count":2,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts\/487\/revisions"}],"predecessor-version":[{"id":490,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts\/487\/revisions\/490"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/media\/493"}],"wp:attachment":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/media?parent=487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/categories?post=487"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/tags?post=487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}