Drugs. 2013 Sep;73(14):1517-24. doi: 10.1007/s40265-013-0106-3.
The mainstay of initial therapy of metastatic prostate cancer has not changed since 1941 when Huggins and Hodges described the efficacy of castration. The benefit of combining an androgen receptor blocker with medical castration has been debatable despite several large randomized trials and meta-analyses intended to answer the question. Recent phase III trial data with continuous versus intermittent androgen deprivation in newly diagnosed metastatic prostate cancer have established continuous therapy as the preferred approach at the present time. Novel and more potent inhibitors of androgen signaling have been developed in the past 5 years and have been validated in castration-resistant disease. Their role in management of hormone-sensitive metastatic prostate cancer is under evaluation in ongoing studies. As androgen deprivation therapy carries significant long-term toxicities including fatigue and loss of bone and muscle mass, an important element of clinical management is prevention and amelioration of these toxicities.
自 1941 年 Huggins 和 Hodges 描述了去势的疗效以来，转移性前列腺癌的初始治疗的主要方法一直没有改变。尽管有几项旨在回答这个问题的大型随机试验和荟萃分析，但联合使用雄激素受体阻滞剂和医学去势的益处仍存在争议。最近在新诊断的转移性前列腺癌中进行的连续与间歇性雄激素剥夺的 III 期试验数据表明，目前连续治疗是首选方法。在过去的 5 年中，已经开发出了新型、更有效的雄激素信号抑制剂，并在去势抵抗性疾病中得到了验证。它们在激素敏感转移性前列腺癌中的作用正在正在进行的研究中进行评估。由于雄激素剥夺疗法会带来显著的长期毒性，包括疲劳以及骨和肌肉质量的丧失，因此预防和改善这些毒性是临床管理的一个重要环节。
