Matzkin H, Chen J, Lewysohn O, Braf Z
Department of Urology, Timsit Institute for Reproductional Endocrinology, Ichilov Hospital, Tel-Aviv, Israel.
J Urol. 1991 Feb;145(2):309-12. doi: 10.1016/s0022-5347(17)38324-6.
Benign prostatic hypertrophy, a common ailment among elderly men, usually is treated by surgery. Since androgens enhance prostatic hypertrophy, their withdrawal seems a logical way to treat this condition. Recently gonadotropin-releasing hormone analogues, known to produce "chemical castration," have been tried in cases of benign prostatic hypertrophy. We report our experience with 20 men treated by a monthly injection of gonadotropin-releasing hormone for prolonged periods. In 17 men treated for 6 months the prostatic volume decreased to an average of 63% of the initial volume; however, this did not correlate with clinical objective improvement. Only 6 men attained normal flow rates. Residual urine volume remained unaltered. Ten patients experienced subjective amelioration, while only 7 (40%) reported objective and subjective improvement. Maximal decrease in prostatic volumes was reached at 9 months of treatment and further treatment did not cause additional shrinkage. At 3 months after discontinuation of treatment prostatic volumes returned to 95 +/- 10.5% of pre-treatment values. A similar decrease in flow rates also was noted. Symptoms remained improved for longer periods. We conclude that this mode of treatment offers little to the majority of men with benign prostatic hypertrophy. Proper patient selection, based perhaps on serum prostate specific antigen, might augment positive results. This therapy should be restricted to patients considered high risk for any surgical and anesthetic intervention, and then it will have to be continued indefinitely.
良性前列腺增生是老年男性的常见疾病，通常通过手术治疗。由于雄激素会加重前列腺增生，停用雄激素似乎是治疗这种疾病的合理方法。最近，已知能产生“化学去势”的促性腺激素释放激素类似物已被用于治疗良性前列腺增生。我们报告了20名男性长期每月注射促性腺激素释放激素的治疗经验。在17名接受6个月治疗的男性中，前列腺体积平均降至初始体积的63%；然而，这与临床客观改善并无关联。只有6名男性达到了正常流速。残余尿量未发生改变。10名患者主观症状有所改善，而只有7名（40%）患者报告了客观和主观两方面的改善。治疗9个月时前列腺体积达到最大降幅，进一步治疗并未导致额外缩小。停药3个月后，前列腺体积恢复至治疗前值的95±10.5%。流速也出现了类似下降。症状改善持续了更长时间。我们得出结论，这种治疗方式对大多数良性前列腺增生男性患者益处不大。或许基于血清前列腺特异性抗原进行恰当的患者选择，可能会增加阳性结果。这种疗法应仅限于那些被认为进行任何手术和麻醉干预风险都很高的患者，而且之后必须无限期持续进行。
