Mid Michigan Health Centers, Allegiance Health, Jackson, Michigan, USA.
Int J Clin Pract. 2010 Dec;64(13):1746-53. doi: 10.1111/j.1742-1241.2010.02541.x.
Androgens not only play an important role in the development and function of the prostate but they are also intimately involved in the development and progression of prostate cancer (PCa). Within the prostate, testosterone is converted to the more potent androgen dihydrotestosterone (DHT) via the action of 5α-reductase enzymes. DHT is the primary prostatic androgen and promotes the growth and survival of normal, hyperplastic and malignant prostate tissues. Throughout the different stages of PCa [prostatic intraepithelial neoplasia (PIN), localised, recurrent, and metastatic] there is an increase in expression of 5α-reductase enzymes, particularly in localised high-grade carcinoma. Specifically inhibiting 5α-reductase may reduce the production of DHT in the prostate while maintaining other endogenous hormone levels. Clinical studies have shown significant PCa risk reduction by blocking this pathway with 5α-reductase inhibitors (5ARIs). However, this comes at a risk, albeit low, with sexual side effects, gynaecomastia and cardiac failure. In addition, one study has shown a slight, but significant, risk of high-grade PCa. The currently available evidence does not support the routine use of 5α-reductase inhibitors to prevent PCa in the general population. It could, however, be considered as an individual option for high-risk or concerned patients with appropriate education from the prescribing provider.
雄激素不仅在前列腺的发育和功能中发挥重要作用，而且还与前列腺癌（PCa）的发生和进展密切相关。在前列腺内，睾酮通过 5α-还原酶的作用转化为更有效的雄激素二氢睾酮（DHT）。DHT 是主要的前列腺雄激素，促进正常、增生和恶性前列腺组织的生长和存活。在 PCa 的不同阶段[前列腺上皮内瘤变（PIN）、局限性、复发性和转移性]，5α-还原酶的表达增加，特别是在局限性高级别癌中。特别地，抑制 5α-还原酶可能会减少前列腺中 DHT 的产生，同时维持其他内源性激素水平。临床研究表明，通过用 5α-还原酶抑制剂（5ARIs）阻断该途径可显著降低 PCa 的风险。然而，这存在一定的风险，尽管风险较低，但会出现性副作用、男性乳房发育和心力衰竭。此外，一项研究表明，高级别 PCa 的风险略有但显著增加。目前的证据并不支持在普通人群中常规使用 5α-还原酶抑制剂来预防 PCa。然而，对于高危或有顾虑的患者，可以考虑作为一种个体选择，并由处方提供者提供适当的教育。
