Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Natl Compr Canc Netw. 2010 Feb;8(2):211-23. doi: 10.6004/jnccn.2010.0014.
Androgen deprivation therapy (ADT) plays a central role in the management of men with locally advanced, recurrent, and metastatic prostate cancer. Because most men diagnosed with prostate cancer will die of something other than their cancer, treatment-related adverse effects are highly relevant to their long-term health. Benefits of ADT in each clinical setting must be weighed against ADT-related adverse effects. ADT is detrimental to several metabolic end points and to bone health. ADT has been prospectively shown to cause decreased lean muscle mass, increased fat mass, weight gain, increased cholesterol and triglycerides, insulin resistance, and loss of bone mineral density. In population-based analyses it has been associated with an increased incidence of diabetes, clinical fractures, and cardiovascular disease. Data-driven recommendations for managing these adverse effects are needed. Currently the authors advocate the use of adapted practice guidelines developed to prevent diabetes, fractures, and coronary heart disease in the general population.
雄激素剥夺疗法（ADT）在治疗局部晚期、复发性和转移性前列腺癌的男性中起着核心作用。由于大多数被诊断为前列腺癌的男性并非死于癌症，因此与治疗相关的不良反应与他们的长期健康密切相关。在每种临床情况下，ADT 的益处必须与 ADT 相关的不良反应进行权衡。ADT 对多种代谢终点和骨骼健康都有不利影响。前瞻性研究表明 ADT 会导致肌肉减少、脂肪增加、体重增加、胆固醇和甘油三酯升高、胰岛素抵抗以及骨密度降低。在基于人群的分析中，ADT 与糖尿病、临床骨折和心血管疾病的发病率增加有关。需要针对这些不良反应制定数据驱动的管理建议。目前，作者提倡使用为预防一般人群中的糖尿病、骨折和冠心病而制定的适应性临床实践指南。
