Zaitsu Masayoshi, Yamanoi Mariko, Mikami Koji, Takeshima Yuta, Okamoto Naohiko, Imao Sadao, Tonooka Akiko, Takeuchi Takumi
Department of Urology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki 211-8510, Japan.
Adv Urol. 2012;2012:979154. doi: 10.1155/2012/979154. Epub 2011 Jun 15.
Background. Most patients with metastatic prostate cancer are endocrinologically treated with LHRH agonist, but finally castration-refractory and hormone-refractory cancers occur. Serum testosterone levels get low to "the castration level" by LHRH agonists but may not get low enough against castration-refractory prostate cancer. Methods. As case series, twelve patients suffering from hormone-refractory prostate cancer continuously on LHRH agonist underwent surgical castration. Additionally, one hundred and thirty-nine prostate cancer patients on LHRH agonist or surgical castration were tested for serum total testosterone levels. Results. Surgical castration caused decrease in serum PSA in one out of 12 hormone-refractory prostate cancer patients with PSA reduction rate 74%. Serum total testosterone levels were below the sensitivity threshold (0.05 ng/mL) in 40 of 89 (44.9%) medically castrated patients and 33 of 50 (66.0%) surgically castrated patients (P = .20). Conclusion. Even hormone-refractory prostate cancer patients are candidates for surgical castration because of endocrinological, oncological, and economical reasons.
背景。大多数转移性前列腺癌患者接受促黄体激素释放激素（LHRH）激动剂内分泌治疗，但最终会出现去势抵抗性和激素抵抗性癌症。LHRH激动剂可使血清睾酮水平降至“去势水平”，但对于去势抵抗性前列腺癌可能无法降至足够低的水平。方法。作为病例系列研究，12例持续接受LHRH激动剂治疗的激素抵抗性前列腺癌患者接受了手术去势。此外，对139例接受LHRH激动剂或手术去势的前列腺癌患者进行了血清总睾酮水平检测。结果。12例激素抵抗性前列腺癌患者中有1例接受手术去势后血清前列腺特异性抗原（PSA）下降，PSA降低率为74%。89例药物去势患者中有40例（44.9%）血清总睾酮水平低于检测阈值（0.05 ng/mL），50例手术去势患者中有33例（66.0%）低于该阈值（P = 0.20）。结论。由于内分泌、肿瘤学和经济学原因，即使是激素抵抗性前列腺癌患者也适合接受手术去势。
