Ryan Charles J, Small Eric J
Department of Medicine, UCSF Comprehensive Cancer Center, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94143, USA.
J Natl Compr Canc Netw. 2004 May;2(3):261-8. doi: 10.6004/jnccn.2004.0023.
Androgen deprivation is the foundation for the systemic therapy of advanced prostate cancer. Multiple trials have tested combined androgen blockade versus androgen deprivation alone in patients with advanced disease. These studies suggest a slight advantage to the combined approaches that contain flutamide and bicalutamide, but the lack of dramatic differences in outcome makes monotherapy reasonable, especially in patients with more indolent disease. Intermittent androgen deprivation is an alternative that may allow patients to reduce the total time on androgen suppression as well as possibly delay the onset of androgen independence. A number of secondary hormonal therapies, including deferred and secondary antiandrogens, ketoconazole, and estrogens have shown modest response proportions. Patients with less advanced disease such as a rising prostate-specific antigen have varied outcomes, and no standard approach exists. In this group, noncastrating forms of hormonal therapy are being evaluated. Patients undergoing definitive local therapy who have high-risk features may benefit from early, as opposed to deferred, androgen deprivation. This review examines the evidence for the current state of the art in hormonal therapy in patients with prostate cancer and focuses, in particular, on treatment composition and timing as well as the rationale for the use of hormonal therapy in early stage disease.
雄激素剥夺是晚期前列腺癌全身治疗的基础。多项试验在晚期疾病患者中比较了联合雄激素阻断与单纯雄激素剥夺治疗。这些研究表明，包含氟他胺和比卡鲁胺的联合治疗方法略有优势，但结果差异不显著，因此单药治疗也是合理的，尤其是对于病情较为惰性的患者。间歇性雄激素剥夺是一种替代方案，可能使患者减少雄激素抑制的总时间，并可能延迟雄激素非依赖的发生。一些二线激素治疗，包括延迟和二线抗雄激素药物、酮康唑和雌激素，显示出一定比例的缓解。疾病进展较轻的患者，如前列腺特异性抗原升高的患者，预后各不相同，且尚无标准治疗方法。在这组患者中，正在评估非去势形式的激素治疗。接受确定性局部治疗且具有高危特征的患者可能从早期而非延迟的雄激素剥夺治疗中获益。本综述探讨了前列腺癌患者激素治疗的现有证据，特别关注治疗组成和时机，以及早期疾病使用激素治疗的理论依据。
