Goetz Tabitha, Burnett Arthur L
Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, 600 N. Wolfe St/Marburg 407, Baltimore, MD, 21287-2411, USA.
Int Urol Nephrol. 2014 Apr;46(4):757-60. doi: 10.1007/s11255-013-0583-z. Epub 2013 Oct 18.
Patients with recurrent ischemic priapism have historically been treated with anti-androgen therapy due to the limited available evidence for more targeted therapies to treat the underlying pathophysiologic mechanisms of this condition. We report a case in which anti-androgen therapy caused significant adverse side effects and likely masked this patient's elevated prostate-specific antigen (PSA) levels, which adversely impacted the timely diagnosis and treatment of his prostate cancer.
A 69-year-old man treated with anti-androgens for priapism initially developed unwanted anti-androgenic side effects such as gynecomastia, erectile dysfunction, and decreased libido. After decreasing his anti-androgen dosage and starting a specified regimen of phosphodiesterase type 5 inhibitor therapy, his serum PSA levels were found to be elevated. He was subsequently diagnosed with adenocarcinoma of the prostate and underwent a radical prostatectomy with the pathologic finding of high-grade, locally progressive disease.
Anti-androgen therapy carries significant complication risks, including the potential to alter the diagnosis and treatment of prostate cancer. Clinicians administering this therapy for priapism management should be aware of these possible risks.
由于针对复发性缺血性阴茎异常勃起潜在病理生理机制的更具针对性疗法的现有证据有限，历史上一直采用抗雄激素疗法治疗此类患者。我们报告了一例抗雄激素疗法引起严重不良副作用且可能掩盖了该患者前列腺特异性抗原（PSA）水平升高的病例，这对其前列腺癌的及时诊断和治疗产生了不利影响。
一名69岁男性因阴茎异常勃起接受抗雄激素治疗，最初出现了诸如男性乳房发育、勃起功能障碍和性欲减退等不良抗雄激素副作用。在降低抗雄激素剂量并开始特定的5型磷酸二酯酶抑制剂治疗方案后，发现他的血清PSA水平升高。随后他被诊断为前列腺腺癌，并接受了根治性前列腺切除术，病理结果显示为高级别、局部进展性疾病。
抗雄激素疗法存在重大并发症风险，包括改变前列腺癌诊断和治疗的可能性。为治疗阴茎异常勃起而使用该疗法的临床医生应意识到这些潜在风险。
