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| 前列腺癌共病抑郁症的研究进展 |
| Research progress in prostate cancer comorbidity depression |
| 投稿时间：2025-09-09 修订日期：2026-01-25 |
| DOI： |
| 中文关键词: 前列腺癌；抑郁症；雄激素剥夺治疗；发病机制 |
| 英文关键词: Prostate cancer；Depression；Androgen deprivation treatment；Pathogenesis |
| 基金项目: |
| 作者 | 单位 | 邮编 | | 邱忠俭 | 济宁医学院临床医学院（附属医院） | | | 朱志国* | 济宁医学院附属医院泌尿外科 | 272000 |
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| 中文摘要: |
| 前列腺癌（prostate cancer, PCa）患者抑郁症发病率显著高于普通人群（8.2% vs 3.8%），且高风险前列腺癌患者、接受手术或雄激素剥夺治疗（Androgen deprivation therapy, ADT）患者风险尤高。这种共病现象严重损害患者生活质量，导致前列腺癌患者的不良预后。抑郁症对前列腺癌患者预后的不良影响包括促使患者选择保守治疗而非根治性方案、降低治疗依从性、增加生化复发风险（34%）、增加自杀风险（3倍）及心血管疾病风险（51%）等方面。其病理生理机制复杂，涉及神经内分泌、免疫炎症等多维度交互作用，例如交感-肾上腺髓质（Sympathetic-adrenal medullary, SAM）轴和雄激素受体（Androgen receptors, AR）信号通路的功能改变。未来研究方向包括分子通路机制的研究、预测ADT抑郁风险的生物标志物的研究等方面，例如深入解析NPY-MDSC轴、IL-6/STAT3信号通路等关键分子机制，并开发多维度生物标志物组合（如IL-6联合睾酮水平）用于预测ADT相关抑郁风险，以期给共病患者带来更加精准诊疗和个体化干预策略。 |
| 英文摘要: |
| The incidence of depression in patients with prostate cancer (PCa) is significantly higher than in the general population (8.2% vs. 3.8%), with particularly elevated risk observed among patients with high-risk PCa and those undergoing surgery or androgen deprivation therapy (ADT). This comorbidity severely impairs patients' quality of life and is closely associated with poor clinical outcomes. The underlying pathophysiological mechanisms are complex, involving multidimensional interactions among neuroendocrine，immune-inflammatory, and treatment-related factors—for example, the sustained activation of the Sympathetic-adrenal medullary (SAM) axis and functional alterations in the androgen receptor (AR) signaling pathway. Depression negatively affects the prognosis of PCa patients in several ways. It may lead patients to choose conservative rather than curative treatments, reduce treatment adherence, and increase the risk of biochemical recurrence by 34%. It also raises the risk of suicide threefold and increases the likelihood of cardiovascular disease by 51%. For patients with comorbid depression and PCa, clinical interventions should adopt an integrated biopsychosocial approach. Future research directions include the study of molecular pathway mechanisms and the investigation of biomarkers for predicting the risk of ADT-related depression. For example, in-depth analysis of key molecular mechanisms such as the NPY-MDSC axis and the IL-6/STAT3 signaling pathway, as well as the development of multi-dimensional biomarker combinations (such as IL-6 combined with testosterone levels) to predict the risk of ADT-related depression, aiming to provide more precise diagnosis, treatment, and personalized intervention strategies for patients with comorbidities. |
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