Ohlmann C H, Thelen P
Klinik für Urologie und Kinderurologie, Universität des Saarlandes, 66421, Homburg/Saar, Deutschland.
Klinik für Urologie, Universitätsmedizin Göttingen, 37099 Göttingen, Deutschland.
Urologe A. 2017 Apr;56(4):465-471. doi: 10.1007/s00120-017-0340-5.
Androgen deprivation is still standard therapy for prostate cancer, either as primary androgen deprivation therapy or with the use of secondary hormonal drugs including abiraterone and enzalutamide. However, especially the clinically occult side effects like metabolic changes or cardiovascular complications and effects on the psyche of the patient are often not recognized in daily practice. Active monitoring of such side effects is essential for prevention and early intervention. In addition, the efficacy of androgen deprivation therapies is limited by primary and secondary resistance. The underlying molecular mechanism including splice variants of the androgen receptor in contrast to mutations are usually reversible and should be regarded as a sign of efficacy of the current treatment. Therefore, the clever, timely use of androgen deprivation or even the use of a bipolar androgen therapy should enable reversal of resistance to again render tumor cells sensitive to androgen-deprivation therapy.
雄激素剥夺疗法仍然是前列腺癌的标准治疗方法，无论是作为主要的雄激素剥夺疗法，还是使用包括阿比特龙和恩杂鲁胺在内的二线激素药物。然而，特别是代谢变化或心血管并发症等临床隐匿性副作用以及对患者心理的影响，在日常实践中往往未被认识到。对此类副作用进行积极监测对于预防和早期干预至关重要。此外，雄激素剥夺疗法的疗效受到原发性和继发性耐药性的限制。与突变相反，包括雄激素受体剪接变体在内的潜在分子机制通常是可逆的，应被视为当前治疗疗效的标志。因此，巧妙、及时地使用雄激素剥夺疗法，甚至使用双相雄激素疗法，应能使耐药性逆转，再次使肿瘤细胞对雄激素剥夺疗法敏感。
