Sunnybrook Health Sciences Centre, Division of Urology, University of Toronto, 2075 Bayview Ave. #MG408, Toronto, Ontario, M4N 3M5, Canada.
Curr Urol Rep. 2013 Jun;14(3):159-67. doi: 10.1007/s11934-013-0325-x.
Intermittent androgen deprivation is increasingly employed as an alternative to continuous life long androgen deprivation therapy for men with advanced or recurrent prostate cancer. Two recent phase III trials have clarified the benefits of intermittent therapy. In men with non-metastatic disease with PSA recurrence after definitive local therapy, intermittent therapy showed equivalent survival to continuous therapy, with significant improvements in quality of life. Patients on intermittent therapy experience improved bone health, less metabolic and hematologic disturbances, fewer hot flashes, as well as improved sexual function. In men with metastatic disease, the data is less clear. The long-awaited results of SWOG 9324 comparing intermittent to continuous therapy in metastatic disease showed a trend to worse outcome in the patients with 'minimal' metastatic disease, and no difference in those with widespread bone mets. The significance of this observation is in dispute. This review also addresses practical issues in the use intermittent therapy, including patient selection, follow-up and cycling of therapy. The recent results of randomized clinical trials now establish that intermittent androgen deprivation therapy is an approach that should be considered the standard of care for most patients with non-metastatic prostate cancer requiring hormonal therapy.
间歇性雄激素剥夺治疗越来越多地被用于替代晚期或复发性前列腺癌男性的终身持续雄激素剥夺治疗。两项最近的 III 期试验阐明了间歇性治疗的益处。对于局部治疗后 PSA 复发的非转移性疾病患者，间歇性治疗与连续治疗的生存获益相当，但生活质量显著改善。接受间歇性治疗的患者骨健康状况改善，代谢和血液学紊乱减少，热潮红减少，性功能也得到改善。对于转移性疾病患者，数据则不太明确。期待已久的 SWOG 9324 试验结果比较了转移性疾病中间歇性治疗与连续治疗，结果显示“轻微”转移性疾病患者的预后较差，但广泛骨转移患者的结果无差异。这一观察结果的意义存在争议。本文还讨论了间歇性治疗的实际问题，包括患者选择、随访和治疗周期。最近的随机临床试验结果现在确立了间歇性雄激素剥夺治疗是大多数需要激素治疗的非转移性前列腺癌患者的标准治疗方法。
