Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8852, USA.
Endocr Relat Cancer. 2010 Oct 29;17(4):R305-15. doi: 10.1677/ERC-10-0187. Print 2010 Dec.
Androgen deprivation therapy (ADT) with gonadal testosterone depletion is the frontline treatment for advanced prostate cancer. Other hormonal interventions have a role in the treatment of prostate cancer. We sought to examine systematically the evidence for hormonal interventions in prostate cancer, risks of ADT, and interventions that mitigate these risks. Search results for therapeutic studies were focused primarily on randomized controlled clinical trials, and the Jadad scale criteria were used to evaluate the quality of these studies. Four trials of the efficacy of intermittent ADT versus continuous ADT were included. One randomized study analysis and six postrandomization analyses were included on the effects of ADT on cardiovascular mortality. Seven randomized controlled trials of pharmacologic interventions were included for the treatment of metabolic effects due to ADT. One randomized trial of GnRH antagonist versus GnRH agonist was included. Six phase I/II clinical trials of secondary hormonal therapies with novel mechanisms of action were included. Randomized studies completed to date indicate that intermittent ADT might be equivalent to continuous ADT. Although adverse effects of ADT include risk factors for cardiovascular disease, effects on cardiovascular mortality are uncertain. Bone loss and increased risk of fracture may be effectively treated with pharmacologic interventions. Benefits of ADT must be balanced with a consideration of the risks.
去势治疗（ADT）联合性腺去睾丸激素治疗是晚期前列腺癌的一线治疗方法。其他激素干预措施在前列腺癌的治疗中也有一定作用。我们旨在系统地研究前列腺癌的激素干预措施、ADT 的风险以及减轻这些风险的干预措施的证据。治疗研究的搜索结果主要集中在随机对照临床试验上，并使用 Jadad 量表标准来评估这些研究的质量。纳入了四项间歇性 ADT 与连续 ADT 疗效的随机试验。纳入了一项关于 ADT 对心血管死亡率影响的随机研究分析和六项随机后分析。纳入了 7 项关于 ADT 代谢作用的药物干预的随机对照试验。纳入了 GnRH 拮抗剂与 GnRH 激动剂的一项随机试验。纳入了 6 项具有新型作用机制的二线激素治疗的 I/II 期临床试验。迄今为止完成的随机研究表明，间歇性 ADT 可能与连续 ADT 等效。尽管 ADT 的不良反应包括心血管疾病的危险因素，但对心血管死亡率的影响尚不确定。药物干预可有效治疗骨质流失和骨折风险增加。ADT 的益处必须与风险的考虑相平衡。
