Chi Kim N, Nguyen Paul L, Higano Celestia S
From the BC Cancer Agency - Vancouver Cancer Centre, Vancouver, British Columbia, Canada; Dana-Farber Cancer Institute, Boston, MA; Univeristy of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA.
Am Soc Clin Oncol Educ Book. 2013. doi: 10.1200/EdBook_AM.2013.33.e176.
Androgen deprivation therapy (ADT) is the mainstay systemic treatment of prostate cancer because of the androgen dependence of the disease. Although ADT has long been used to manage prostate cancer, its use continues to evolve as data from clinical trials mature and long-term effects are recognized. For patients with localized disease and high-risk features, short and long courses of ADT as neoadjuvant/adjuvant therapy have been shown to improve survival when used with radiation therapy, but this has not been demonstrated with radical prostatectomy. The role of ADT with salvage radiotherapy after radical prostatectomy continues to be defined. Lifelong ADT in patients with node-positive disease after surgery or with radiation is also associated with increased survival. Increasingly though, the adverse effects of ADT that go beyond those on libido and hot flashes are being acknowledged. The metabolic effects on lipids, glycemic control, and bone loss from ADT can lead to an increased risk of cardiovascular events and osteoporosis, which needs to be considered when deciding to initiate and treat patients with ADT. Large, randomized trials comparing intermittent to continuous ADT have now been reported. Although the hope for improved cancer outcomes with intermittent therapy has not come to realization, an interrupted approach to therapy may help mitigate some of the negative effects of ADT in selected patients by allowing for off-treatment intervals.
由于前列腺癌对雄激素的依赖性，雄激素剥夺疗法（ADT）是前列腺癌的主要全身治疗方法。尽管ADT长期以来一直用于治疗前列腺癌，但随着临床试验数据的成熟和长期效果的被认识，其应用仍在不断发展。对于患有局限性疾病且具有高危特征的患者，新辅助/辅助治疗中短期和长期的ADT与放射治疗联合使用时已显示可提高生存率，但在根治性前列腺切除术中尚未得到证实。根治性前列腺切除术后挽救性放疗联合ADT的作用仍有待确定。手术后或放疗后淋巴结阳性患者的终身ADT也与生存率提高相关。然而，越来越多的人认识到ADT的不良影响超出了对性欲和潮热的影响。ADT对脂质、血糖控制和骨质流失的代谢影响可导致心血管事件和骨质疏松症的风险增加，在决定启动和治疗ADT患者时需要考虑这一点。现在已经报道了比较间歇性ADT和持续性ADT的大型随机试验。尽管间歇性治疗改善癌症结局的希望尚未实现，但通过允许治疗间隔期，中断治疗方法可能有助于减轻部分选定患者ADT的负面影响。
