de Jong Igle Jan, Eaton Alan, Bladou Franck
Department of Urology, University Medical Center Groningen, University of Groningen, The Netherlands.
Curr Med Res Opin. 2007 May;23(5):1077-80. doi: 10.1185/030079907x187973.
Options for lowering testosterone in patients with prostate cancer include bilateral orchiectomy, oestrogens and luteinising hormone-releasing hormone (LHRH) agonists. LHRH agonists have become widely used in the treatment of prostate cancer.
In May 2006, a team of experts convened a roundtable assembly to discuss key issues associated with the use of LHRH agonists in the treatment of prostate cancer.
The discussion centred on the frequency of treatment with LHRH agonists, the role of serum testosterone (ST) measurement as part of routine follow-up, and the recommended castrate level of ST. Several formulations of LHRH agonists are available, including 3-month depots that coincide with visit frequency for prostate-specific antigen (PSA) testing. Appropriate monitoring of patients receiving LHRH agonists continues to be based on PSA levels. ST determination is not recommended as part of routine follow-up, and does not provide additional prognostic benefit or improved overall management for the majority of patients. However, determination of ST may be useful in selected patients, such as those with rising PSA levels or in cases where there is doubt over LHRH agonist administration or absorption. Achieving levels of ST similar to those obtained after orchiectomy is important for patient outcomes, although there is no evidence that a lower ST level (<50 ng/dl) results in additional clinical benefits.
LHRH agonists should be considered first-choice testosterone-lowering therapy for the treatment of prostate cancer, with the 3-month depot formulation providing optimal convenience and flexibility. Assessment of patients receiving LHRH agonists should be based on PSA levels rather than ST levels, although levels of ST similar to those obtained after orchiectomy still need to be achieved. Further studies are warranted before the potential therapeutic benefit of considerably lowered ST levels can be fully assessed.
降低前列腺癌患者睾酮水平的方法包括双侧睾丸切除术、雌激素和促黄体生成素释放激素（LHRH）激动剂。LHRH激动剂已广泛应用于前列腺癌的治疗。
2006年5月，一组专家召开了一次圆桌会议，讨论与使用LHRH激动剂治疗前列腺癌相关的关键问题。
讨论集中在LHRH激动剂的治疗频率、血清睾酮（ST）测量作为常规随访一部分的作用以及推荐的ST去势水平。有几种LHRH激动剂制剂可供选择，包括与前列腺特异性抗原（PSA）检测的就诊频率一致的3个月长效制剂。对接受LHRH激动剂治疗的患者进行适当监测仍基于PSA水平。不建议将ST测定作为常规随访的一部分，并且对大多数患者而言，ST测定并不能提供额外的预后益处或改善整体管理。然而，ST测定可能对某些特定患者有用，例如PSA水平升高的患者或对LHRH激动剂给药或吸收存在疑问的情况。尽管没有证据表明较低的ST水平（<50 ng/dl）会带来额外的临床益处，但达到与睾丸切除术后相似的ST水平对患者的预后很重要。
LHRH激动剂应被视为治疗前列腺癌降低睾酮水平的首选疗法，3个月长效制剂提供了最佳的便利性和灵活性。对接受LHRH激动剂治疗的患者的评估应基于PSA水平而非ST水平，尽管仍需达到与睾丸切除术后相似的ST水平。在能够充分评估大幅降低ST水平的潜在治疗益处之前，有必要进行进一步研究。
