Lam John S, Leppert John T, Vemulapalli Sreenivas N, Shvarts Oleg, Belldegrun Arie S
Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA.
J Urol. 2006 Jan;175(1):27-34. doi: 10.1016/S0022-5347(05)00034-0.
Androgen ablation remains the cornerstone of management for advanced prostate cancer. Therapeutic options in patients with progressive disease following androgen deprivation include antiandrogen withdrawal, secondary hormonal agents and chemotherapy. Multiple secondary hormonal agents have clinical activity and the sequential use of these agents may lead to prolonged periods of clinical response. We provide a state-of-the-art review of the various agents currently used for secondary hormonal manipulation and discusses their role in the systemic treatment of patients with prostate cancer.
A comprehensive review of the peer reviewed literature was performed on the topic of secondary hormonal therapies, including oral antiandrogens, adrenal androgen inhibitors, corticosteroids, estrogenic compounds, gonadotropin-releasing hormone antagonists and alternative hormonal therapies for advanced prostate cancer.
Secondary hormonal therapies can provide a safe and effective treatment option in patients with AIPC. The use of steroids and adrenolytics, such as ketoconazole and aminoglutethimide, has resulted in symptomatic improvement and a greater than 50% prostate specific antigen decrease in a substantial percent of patients with AIPC. A similar clinical benefit has been demonstrated with estrogen based therapies. Furthermore, these therapies have demonstrated a decrease in metastatic disease burden. Other novel hormonal therapies are currently under investigation and they may also show promise as secondary hormonal therapies. Finally, guidelines from the United States Food and Drug Administration Prostate Cancer Endpoints Workshop were reviewed in the context of developing new agents.
Secondary hormonal therapy serves as an excellent therapeutic option in patients with AIPC in whom primary hormonal therapy has failed. Practicing urologists should familiarize themselves with these oral medications, their indications and their potential side effects.
雄激素剥夺仍然是晚期前列腺癌治疗的基石。雄激素剥夺治疗后疾病进展患者的治疗选择包括抗雄激素撤药、二线激素药物和化疗。多种二线激素药物具有临床活性，序贯使用这些药物可能会带来较长时间的临床反应。我们对目前用于二线激素治疗的各种药物进行了最新综述，并讨论了它们在前列腺癌患者全身治疗中的作用。
对同行评审文献中关于二线激素治疗的主题进行了全面综述，包括口服抗雄激素药物、肾上腺雄激素抑制剂、皮质类固醇、雌激素化合物、促性腺激素释放激素拮抗剂以及晚期前列腺癌的替代激素治疗。
二线激素治疗可为雄激素非依赖性前列腺癌（AIPC）患者提供安全有效的治疗选择。使用类固醇和肾上腺溶解剂，如酮康唑和氨鲁米特，已使相当一部分AIPC患者症状改善，前列腺特异性抗原下降超过50%。基于雌激素的疗法也显示出类似的临床益处。此外，这些疗法已证明转移性疾病负担有所减轻。目前正在研究其他新型激素疗法，它们作为二线激素疗法也可能显示出前景。最后，在美国食品药品监督管理局前列腺癌终点研讨会的指导原则背景下对新药物的研发进行了综述。
二线激素治疗是原发性激素治疗失败的AIPC患者的极佳治疗选择。执业泌尿科医生应熟悉这些口服药物、其适应证及其潜在副作用。
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