Brawer Michael K
Rev Urol. 2006;8 Suppl 2(Suppl 2):S35-47.
Updates on hormonal therapy in the treatment of prostate cancer are presented. The most common therapy is to reduce testosterone to castrate levels. A dosage of 1 mg diethylstilbestrol daily prolonged survival in patients with advanced prostate cancer. The leuteinizing hormone-releasing hormone agonists have essentially replaced surgical orchiectomy in the vast majority of clinical settings; however, a major problem with the leuteinizing hormone- releasing hormone agonists has been the surge and flare of testosterone levels. If hormonal therapy is initiated early, the risk of major complications is significantly decreased. Combined androgen blockade is better than monotherapy, although there is only a small clinical benefit. When androgen deprivation is used for a short time and the normal androgen milieu is re-established, the side effects and toxicity of androgen deprivation are decreased. The major complications of androgen deprivation include hot flushes, reduction of bone mineral density, osteoporosis, and anemia. Intermittent androgen blockade might have the same benefits of total androgen suppression with fewer side effects, increased duration of androgen dependence, and less cost. The 10 steps to take when advising patients about initiation of androgen deprivation therapy are reviewed.
本文介绍了前列腺癌治疗中激素疗法的最新进展。最常见的疗法是将睾酮降低至去势水平。每日服用1毫克己烯雌酚可延长晚期前列腺癌患者的生存期。在绝大多数临床情况下，促黄体激素释放激素激动剂已基本取代了手术去势；然而，促黄体激素释放激素激动剂的一个主要问题是睾酮水平的激增和波动。如果早期开始激素治疗，主要并发症的风险会显著降低。联合雄激素阻断优于单一疗法，尽管临床益处较小。当短期使用雄激素剥夺并重新建立正常的雄激素环境时，雄激素剥夺的副作用和毒性会降低。雄激素剥夺的主要并发症包括潮热、骨矿物质密度降低、骨质疏松和贫血。间歇性雄激素阻断可能具有与完全雄激素抑制相同的益处，且副作用更少、雄激素依赖持续时间增加且成本更低。本文还回顾了在向患者建议开始雄激素剥夺治疗时应采取的10个步骤。
