Pfitzenmaier J, Altwein J E
Urologische Universitätsklinik Heidelberg, INF 110, Heidelberg.
Aktuelle Urol. 2009 Mar;40(2):100-8. doi: 10.1055/s-0028-1098746. Epub 2009 Feb 27.
In this review the current indications and the options for LHRH analogues are elucidated. For this purpose, a literature search in PubMed and the Cochrane-Database was performed. In addition, the EAU and AUA guidelines as well as actual meeting abstracts up to 2008 were taken into account. Since the first prospective study in 1991 showed the same effectivity for LHRH analogues and orchiectomy in metastasised prostate cancer patients, the use of LHRH analogues increased thereafter. Testosterone levels do not need to be checked regularly, but rather only when PSA rises again under treatment. After cessation of LHRH analogue treatment the time to testosterone level recovery is longer when the treatment time was longer. One must especially recognise the risks of diabetes and osteoporosis after more than 3 years of LHRH analogue treatment. In the case of neoadjuvant and adjuvant LHRH analogue treatment, several points have to be taken into consideration: LHRH analogues before radical prostatectomy lead to a lower positive margin rate and lower rate of lymph node metastasis, but tumour-specific survival is not improved. In contrast, neoadjuvant LHRH analogue treatment before radiation therapy leads to better tumour-specific and overall survival. An increased cardiovascular toxicity was not observed. Intermittent androgen ablation has been proved to be equivalent with a reduction of side effects. Hormonal salvage therapy should be initiated when the PSA doubling time is short or the PSA velocity is > 2 ng / mL / year. The benefit of early initiation (PSA < 10 ng / mL, PSA doubling time < 12 months) is that it can prolong the metastasis-free survival time.
在本综述中，阐明了促黄体生成素释放激素（LHRH）类似物的当前适应证和选择。为此，在PubMed和Cochrane数据库中进行了文献检索。此外，还考虑了欧洲泌尿外科学会（EAU）和美国泌尿外科学会（AUA）的指南以及截至2008年的实际会议摘要。自1991年的第一项前瞻性研究表明LHRH类似物与去势手术对转移性前列腺癌患者具有相同疗效以来，LHRH类似物的使用此后有所增加。睾酮水平无需定期检查，而是仅在治疗期间前列腺特异性抗原（PSA）再次升高时检查。LHRH类似物治疗停止后，治疗时间越长，睾酮水平恢复所需时间越长。必须特别认识到LHRH类似物治疗超过3年后发生糖尿病和骨质疏松症的风险。在新辅助和辅助LHRH类似物治疗的情况下，有几点必须考虑：根治性前列腺切除术前行LHRH类似物治疗可降低切缘阳性率和淋巴结转移率，但肿瘤特异性生存率并未提高。相比之下，放疗前行新辅助LHRH类似物治疗可提高肿瘤特异性生存率和总生存率。未观察到心血管毒性增加。间歇性雄激素剥夺已被证明具有等效性且副作用减少。当PSA倍增时间短或PSA速度>2 ng/mL/年时，应开始激素挽救治疗。早期开始治疗（PSA<10 ng/mL，PSA倍增时间<12个月）的好处是可以延长无转移生存期。
