Wirth M P, Nippgen J
Klinik und Poliklinik für Urologie, Universitätsklinikum "Carl Gustav Carus" der TU Dresden, Dresden.
Urologe A. 2003 Nov;42(11):1453-60. doi: 10.1007/s00120-003-0452-y.
An increasing life expectancy and the growing number of largely healthy older men have lead to more patients with hormone insensitive relapses after palliative hormone or curative therapy for prostate cancer. After 10 years without therapeutic improvement for hormone refractory prostate cancer, the introduction of new substances has led to a revival of chemotherapy. Although a definitive cure is still not possible, such chemotherapy fulfils important palliative criteria-good toleration and an improvement in quality of life-in addition to distinct long-term remission. For example, taxane as a monotherapy or in combination with estramustine is effective and well tolerated while mitoxantrone in combination with prednisolone, although of limited effectiveness, leads to a substantial reduction in symptoms. Although evidence for increased longevity through modern chemotherapy is available, this has still not been definitively demonstrated. The substantial reduction in pain and therapy related morbidity frequently makes chemotherapy for hormone refractive prostate cancer a superior alternative to simple pain and complication management.
预期寿命的增加以及大量健康老年男性数量的增多,导致在前列腺癌进行姑息性激素治疗或根治性治疗后出现激素不敏感复发的患者增多。在激素难治性前列腺癌治疗十年未取得进展之后,新药物的引入使化疗得以复兴。尽管仍无法实现根治,但这种化疗除了能带来明显的长期缓解外,还满足重要的姑息治疗标准——耐受性良好且生活质量得到改善。例如,紫杉烷单药治疗或与雌莫司汀联合使用有效且耐受性良好,而米托蒽醌与泼尼松龙联合使用,尽管效果有限,但能显著减轻症状。虽然有证据表明现代化疗可延长生存期,但这仍未得到确凿证实。疼痛和治疗相关发病率的大幅降低常常使激素难治性前列腺癌的化疗成为单纯疼痛和并发症管理的更佳选择。