Kobayashi Takashi, Nishizawa Koji, Mitsumori Kenji
Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
Scand J Urol Nephrol. 2006;40(3):198-203. doi: 10.1080/00365590600641533.
To evaluate the process of hormonal recovery after cessation of luteinizing hormone-releasing hormone (LHRH) agonist treatment in patients who had received long-term LHRH agonist therapy for prostate cancer.
Men who had successfully undergone androgen deprivation therapy with only monthly LHRH agonist therapy for > 30 months were enrolled and the administration of LHRH agonist was discontinued. Serum total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prostate-specific antigen (PSA) were measured before the cessation of LHRH agonist therapy and every 4 weeks thereafter, and the administration of LHRH agonist remained suspended until the total testosterone level recovered to > 50 ng/dl.
Ten patients were enrolled in the study. The median (range) castration period and the levels of serum LH, FSH, total testosterone and PSA at cessation of therapy were 39 (30-56) months,<0.5 (<0.5-1.8) mIU/ml, 6.4 (3.0-15.9) mIU/ml, 15.3 (5.8-34.7) ng/dl and 0.13 (0.02-0.89) ng/ml, respectively. Testosterone recovered to > 50 ng/dl in all cases. There were large variations in the times required for recovery of LH and FSH (30-100 days) and serum testosterone (30-330 days). PSA began to increase at various testosterone levels, and there was a large variation (0-83%; median 41%) in the ratio of the androgen suppression (testosterone < 50 ng/dl) time to the period of LHRH agonist cessation.
There was considerable variation in the hypothalamus-pituitary-testicular hormone profiles during recovery from long-term medical castration. These findings are noteworthy when interruption of androgen deprivation therapy is applied with the intention of delaying the progression of hormone-refractory cancer or improving the patient's quality of life.
评估接受长期促黄体生成素释放激素（LHRH）激动剂治疗前列腺癌的患者停止该治疗后激素恢复的过程。
纳入仅接受每月一次LHRH激动剂治疗超过30个月且成功接受雄激素剥夺治疗的男性患者，并停止LHRH激动剂给药。在停止LHRH激动剂治疗前及之后每4周测量血清总睾酮、促黄体生成素（LH）、促卵泡生成素（FSH）和前列腺特异性抗原（PSA），且LHRH激动剂给药一直暂停，直至总睾酮水平恢复至>50 ng/dl。
10名患者纳入本研究。治疗期的中位（范围）去势时间以及治疗停止时血清LH、FSH、总睾酮和PSA水平分别为39（30 - 56）个月、<0.5（<0.5 - 1.8）mIU/ml、6.4（3.0 - 15.9）mIU/ml、15.3（5.8 - 34.7）ng/dl和0.13（0.02 - 0.89）ng/ml。所有病例中睾酮均恢复至>50 ng/dl。LH和FSH恢复所需时间（30 - 100天）以及血清睾酮恢复所需时间（30 - 330天）存在较大差异。PSA在不同睾酮水平时开始升高，且雄激素抑制（睾酮<50 ng/dl）时间与LHRH激动剂停止给药期的比值存在较大差异（0 - 83%；中位值41%）。
从长期药物去势恢复过程中，下丘脑 - 垂体 - 睾丸激素谱存在相当大的差异。当为了延缓激素难治性癌症进展或改善患者生活质量而中断雄激素剥夺治疗时，这些发现值得关注。
