非转移性去势抵抗前列腺癌（nmCRPC）是一种临床状态，其定义为已确认接受ADT治疗的患者PSA水平上升，但常规CT和锝-99m放射方法未检测到转移病灶。nmCRPC患者中，PSA倍增时间（PSADT）≤10个月被认为是高风险，可能会迅速发展为转移性疾病，对生存有影响。最近三个三期临床试验证明，在这种情况下，与单一ADT相比，将下一代雄激素受体靶向药物（ARTA）与ADT联用可以延迟转移的发展（无进展生存期，MFS），并延长总生存期。如果考虑到药物相关不良事件的低发生率，这些药物的临床效益将更有意义。我们的评论介绍了最新的nmCRPC管理进展，从关键性临床试验SPARTAN、PROSPER和ARAMIS中得出，旨在支持临床医生更优化地管理这些患者。值得注意的是，新型、更准确的下一代成像技术（包括Ga PSMA-PET/CT），以及可能的未来肿瘤生物标志物的出现，正在修改nmCRPC的实体和定义，对患者的诊断和管理产生影响。版权所有 © 2023作者。由Elsevier Ltd.出版。保留所有权利。

Non-metastatic castration resistant prostate cancer (nmCRPC) is a clinical setting defined as confirmed rising levels of PSA in patients treated with ADT but without detectable metastases on conventional imaging with computerized tomography (CT) and technetium-99 m scintigraphy. Men with nmCRPC and a PSA doubling time (PSADT) ≤ 10 months are considered at high risk of rapidly developing metastases with a consequent possible impact on survival. Three recent phase III trials have demonstrated, in this setting, the efficacy of adding a next-generation androgen receptor targeted agent (ARTA) to ADT in respect to ADT only, in delaying the development of metastases (metastasis-free survival, MFS) and prolong overall survival. The magnitude of clinical benefit of these agents was even more meaningful if considering the low incidence of drug related adverse events. Our review described the latest advances in the management of nmCRPC, deriving from the pivotal clinical trials, SPARTAN, PROSPER and ARAMIS, in order to support clinicians to optimally manage these patients. Of note, the emergence of novel, more accurate, next-generation imaging techniques (including Ga PSMA-PET/CT), as well as eventual future tumor biomarkers, is modifying the entity and definition of the nmCRPC setting, with a consequent impact on patient's diagnosis and management.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.