Sharifi Nima, Gulley James L, Dahut William L
Medical Oncology Clinical Research Unit, National Cancer Institute, Bethesda, MD 20892, USA.
JAMA. 2005 Jul 13;294(2):238-44. doi: 10.1001/jama.294.2.238.
Prostate cancer is the most common nonskin cancer and second most common cause of cancer mortality in US men. Androgen deprivation therapy (ADT), specifically surgical or medical castration, is the first line of treatment against advanced prostate cancer and is also used as an adjuvant to local treatment of high-risk disease.
To review systematically the evidence on the risks and benefits of ADT for prostate cancer as well as clinical management of its adverse effects.
We performed MEDLINE searches of English-language literature (1966 to March 2005) using the terms androgen deprivation therapy, hormone treatment, and prostate cancer. We reviewed bibliographies of literature to extract other relevant articles. Studies were selected based on clinical pertinence, with an emphasis on controlled study design.
Androgen deprivation therapy is effective for palliation in many patients with advanced prostate cancer and improves outcomes for high-risk patients treated with radiation therapy for localized disease. Although patients with increasing prostate-specific antigen levels after local treatment without metastatic disease frequently undergo ADT, the benefits of this strategy are not clear. Adverse effects of ADT include decreased libido, impotence, hot flashes, osteopenia with increased fracture risk, metabolic alterations, and changes in cognition and mood.
Androgen deprivation therapy has clear roles in the management of advanced prostate cancer and high-risk localized disease. The benefits of ADT in other settings need to be weighed carefully against substantial risks and adverse effects on quality of life.
前列腺癌是美国男性中最常见的非皮肤癌，也是癌症死亡的第二大常见原因。雄激素剥夺疗法（ADT），特别是手术去势或药物去势，是晚期前列腺癌的一线治疗方法，也用作高危疾病局部治疗的辅助手段。
系统回顾关于ADT治疗前列腺癌的风险和益处及其不良反应临床管理的证据。
我们使用雄激素剥夺疗法、激素治疗和前列腺癌等术语对1966年至2005年3月的英文文献进行了MEDLINE检索。我们查阅了文献的参考文献以提取其他相关文章。根据临床相关性选择研究，重点是对照研究设计。
雄激素剥夺疗法对许多晚期前列腺癌患者的姑息治疗有效，并改善了局部疾病接受放射治疗的高危患者的预后。尽管局部治疗后无转移疾病但前列腺特异性抗原水平升高的患者经常接受ADT，但这种策略的益处尚不清楚。ADT的不良反应包括性欲减退、阳痿、潮热、骨质减少伴骨折风险增加、代谢改变以及认知和情绪变化。
雄激素剥夺疗法在晚期前列腺癌和高危局部疾病的管理中具有明确作用。在其他情况下，ADT的益处需要与对生活质量的重大风险和不良反应仔细权衡。
