Peters C A, Walsh P C
N Engl J Med. 1987 Sep 3;317(10):599-604. doi: 10.1056/NEJM198709033171004.
We examined the influence of androgens on benign prostatic hyperplasia, using nafarelin acetate, a potent luteinizing-hormone-releasing hormone agonist, to achieve reversible androgen deprivation in men with benign prostatic hyperplasia. Nine patients with bladder-outlet obstruction due to benign prostatic hyperplasia were treated with subcutaneous nafarelin acetate (400 micrograms per day) in an open trial for six months. In all patients, serum testosterone decreased to castrate levels. Objective observations included uroflowmetry, measurement of residual urine volume, determination of prostatic size by ultrasonography, and prostatic biopsy. In all patients, the prostate regressed to a mean (+/- SEM) of 75.8 +/- 3 percent of the initial size (range, 52 to 86; P less than 0.005); the regression reached a plateau after four months. Morphologic analysis of biopsy specimens showed regression of glandular epithelium. Three of nine patients had clinical improvement with treatment. Six months after the cessation of treatment, plasma testosterone levels had returned to normal and the size of the prostate had increased to 99 +/- 5.5 percent of the initial size. These findings suggest that androgens have an important supportive role in established benign prostatic hyperplasia and that testicular suppression will benefit some patients. However, this form of treatment could be applicable only in carefully selected patients who were not surgical candidates, and it would need to be maintained indefinitely.
我们使用强效促黄体生成素释放激素激动剂醋酸奈法林，在良性前列腺增生男性患者中实现可逆性雄激素剥夺，以研究雄激素对良性前列腺增生的影响。在一项开放试验中，9例因良性前列腺增生导致膀胱出口梗阻的患者接受了皮下注射醋酸奈法林（每日400微克）治疗，为期6个月。所有患者的血清睾酮均降至去势水平。客观观察指标包括尿流率测定、残余尿量测量、超声测定前列腺大小以及前列腺活检。所有患者的前列腺均缩小至初始大小的平均（±标准误）75.8±3%（范围为52%至86%；P<0.005）；4个月后缩小达到平台期。活检标本的形态学分析显示腺上皮细胞消退。9例患者中有3例经治疗后临床症状改善。治疗停止6个月后，血浆睾酮水平恢复正常，前列腺大小增加至初始大小的99±5.5%。这些发现表明，雄激素在已确诊的良性前列腺增生中具有重要的支持作用，睾丸抑制对部分患者有益。然而，这种治疗方式仅适用于精心挑选且不适合手术的患者，并且需要无限期维持。
