Department of Urology, Wirral University Teaching Hospitals, Wirral, UK.
BJU Int. 2011 Jun;107(12):1923-9. doi: 10.1111/j.1464-410X.2010.09726.x. Epub 2010 Oct 15.
• To evaluate changes in bone mineral density (BMD), body composition, muscle strength and health-related quality of life (HRQL) during bicalutamide (150 mg) monotherapy in osteoporotic patients with non-metastatic locally advanced prostate cancer. Osteoporosis is prevalent in men presenting with prostate cancer and also a common side effect of treatment with luteinizing hormone-releasing hormone agonists, which are associated with decreased BMD and loss of lean body mass and suppress testosterone, unlike bicalutamide, which results in an increase in serum testosterone and oestrogen levels.
• Forty-two men with non-metastatic locally advanced prostate cancer and osteoporosis (T-score ≤-2.5) were treated with bicalutamide (150 mg) monotherapy. BMD was measured at baseline and 1 year. HRQL was assessed 3-monthly using the RAND 36-Item Health Survey and University of California Los Angeles Prostate Cancer Index questionnaires. Bone turnover markers, liver function tests, prostate-specific antigen, testosterone, oestradiol and haemoglobin were measured at baseline, at 3 weeks and 3-monthly thereafter. Arm anthropometry and dynamometry assessed fat mass, skeletal muscle mass and quadriceps strength.
• BMD was maintained (+2.1% lumbar spine, +1.2% total hip and +1.1% forearm). Prostate-specific antigen decreased by 88% at 3 months. Testosterone and oestradiol had increased at 1 year by 58% and 42%, respectively. No increase in bone turnover markers was seen over 1 year. Quadriceps muscle strength was maintained. General and prostate cancer-specific HRQL were maintained throughout the study, with no significant reductions in physical or sexual function. Adverse events included breast pain and gynaecomastia.
• Bicalutamide preserves BMD, muscle strength and HRQL in osteoporotic men with non-metastatic locally advanced prostate cancer. It provides an alternative to medical castration for well informed men at high fracture risk and those wishing to retain physical and sexual activity, with luteinizing hormone-releasing hormone agonists being reserved for those failing to respond or relapsing.
评估非转移性局部晚期前列腺癌伴骨质疏松症患者接受比卡鲁胺（150mg）单药治疗期间骨密度（BMD）、身体成分、肌肉力量和健康相关生活质量（HRQL）的变化。骨质疏松症在患有前列腺癌的男性中很常见，也是促黄体生成素释放激素激动剂治疗的常见副作用，这些药物会导致 BMD 降低、去脂体重减少和睾酮水平抑制，而比卡鲁胺则会导致血清睾酮和雌激素水平升高。
42 名非转移性局部晚期前列腺癌伴骨质疏松症（T 评分≤-2.5）患者接受比卡鲁胺（150mg）单药治疗。基线和 1 年时测量 BMD。使用 RAND 36-Item 健康调查和加利福尼亚大学洛杉矶前列腺癌指数问卷每 3 个月评估一次 HRQL。基线时、第 3 周和此后每 3 个月测量骨转换标志物、肝功能试验、前列腺特异性抗原、睾酮、雌二醇和血红蛋白。手臂人体测量学和握力计评估脂肪量、骨骼肌量和股四头肌力量。
BMD 保持稳定（腰椎骨+2.1%，全髋关节+1.2%，前臂+1.1%）。前列腺特异性抗原在 3 个月时下降了 88%。睾酮和雌二醇在 1 年内分别增加了 58%和 42%。1 年内未见骨转换标志物增加。股四头肌力量保持不变。一般和前列腺癌特异性 HRQL 在整个研究期间保持不变，身体和性功能没有显著下降。不良事件包括乳房疼痛和男性乳房发育。
比卡鲁胺可维持非转移性局部晚期前列腺癌伴骨质疏松症男性的 BMD、肌肉力量和 HRQL。对于骨折风险高、希望保持身体和性功能的知情男性，它是一种替代医学去势的方法，对于那些对治疗无反应或复发的患者，则保留使用促黄体生成素释放激素激动剂。
