Venner P M
University of Alberta, Cross Cancer Institute, Edmonton, Canada.
Semin Oncol. 1990 Dec;17(6 Suppl 9):73-7.
Considerable controversy continues to surround the therapy of metastatic carcinoma of the prostate. Until recently orchiectomy and diethylstilbestrol (DES) were the only treatment options available. The development of megestrol acetate is of interest because of its broad spectrum of activity and excellent patient acceptability. Interim results of a study comparing megestrol acetate 120 mg/d plus mini-dose DES 0.1 mg/d with DES 3 mg/d are reported. Megestrol acetate had minimal side effects, with 2% of patients withdrawing from the megestrol acetate arm because of toxicity, compared with 37% from the DES arm. Significant cardiovascular toxicity occurred in 33% of patients taking DES and in 7% taking megestrol acetate. Both therapies achieved permanent suppression of serum testosterone to castrate levels. Time to progression and overall survival were longer with DES treatment, 17 versus 23 months and 24 versus 44 months, respectively, but this was not significant (P = .34 and P = .16, respectively). A review of the literature on the treatment of metastatic carcinoma of the prostate is presented to determine what should be recommended as standard therapy. Total androgen blockade is analyzed critically and results of therapy are compared with other modalities. Based on efficacy, cost, toxicity, and patient acceptability, orchiectomy still should be considered standard therapy and total androgen blockade should be considered experimental.
前列腺转移性癌的治疗仍存在诸多争议。直到最近，睾丸切除术和己烯雌酚（DES）还是仅有的可用治疗选择。醋酸甲地孕酮因其广泛的活性谱和极佳的患者接受度而备受关注。本文报告了一项比较醋酸甲地孕酮120mg/d加小剂量DES 0.1mg/d与DES 3mg/d的研究的中期结果。醋酸甲地孕酮的副作用极小，2%的患者因毒性退出醋酸甲地孕酮组，而DES组为37%。服用DES的患者中有33%出现显著的心血管毒性，服用醋酸甲地孕酮的患者中这一比例为7%。两种治疗方法均能将血清睾酮永久性抑制至去势水平。DES治疗的疾病进展时间和总生存期更长，分别为17个月对23个月和24个月对44个月，但差异无统计学意义（P值分别为0.34和0.16）。本文对前列腺转移性癌治疗的文献进行综述，以确定应推荐何种标准治疗方法。对全雄激素阻断进行了批判性分析，并将治疗结果与其他治疗方式进行比较。基于疗效、成本、毒性和患者接受度，睾丸切除术仍应被视为标准治疗方法，全雄激素阻断应被视为试验性治疗方法。
