Oottamasathien Siam, Crawford E David
Department of Surgery, Division of Urology, University of Colorado, Health Sciences Center, Denver, Colorado, USA.
Oncology (Williston Park). 2003 Aug;17(8):1047-52; discussion 1054-8.
Hormonal treatment of advanced prostate cancer should be considered for patients who have stages C and D1 disease, a high risk of recurrence after local therapy, or prostate-specific antigen-measured recurrence after local treatment. This approach is dependent on most prostate cancer cells being androgen-dependent, but androgen-independent cells may arise after several years of hormonal therapy. Options for androgen blockade primarily include orchiectomy, luteinizing hormone-releasing agonists and antagonists, and nonsteroidal antiandrogens. There is some controversy regarding combined androgen blockade, intermittent androgen blockade, and the question of whether early androgen blockade is superior to delayed therapy. Convincing data do exist for the use of adjuvant/neoadjuvant hormonal therapy with external-beam radiation therapy. Although hormonal therapy is an important treatment modality for advanced prostate cancer, long-term treatment carries significant side effects that need to be considered.
对于患有C期和D1期疾病、局部治疗后复发风险高或局部治疗后前列腺特异性抗原测量复发的患者，应考虑对晚期前列腺癌进行激素治疗。这种方法依赖于大多数前列腺癌细胞依赖雄激素，但激素治疗几年后可能会出现不依赖雄激素的细胞。雄激素阻断的选择主要包括睾丸切除术、促黄体激素释放激动剂和拮抗剂以及非甾体类抗雄激素药物。关于联合雄激素阻断、间歇性雄激素阻断以及早期雄激素阻断是否优于延迟治疗的问题存在一些争议。对于辅助/新辅助激素治疗联合外照射放疗确实存在令人信服的数据。尽管激素治疗是晚期前列腺癌的重要治疗方式，但长期治疗会带来需要考虑的显著副作用。
