最大程度睾酮抑制在复发性和转移性前列腺癌治疗中的应用
Maximal testosterone suppression in the management of recurrent and metastatic prostate cancer.
作者信息
Klotz Laurence, Breau Rodney H, Collins Loretta L, Gleave Martin E, Pickles Tom, Pouliot Frederic, Saad Fred
机构信息
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.
出版信息
Can Urol Assoc J. 2017 Jan-Feb;11(1-2):16-23. doi: 10.5489/cuaj.4303.
INTRODUCTION
Testosterone suppression, or androgen-deprivation therapy (ADT), is an established treatment for recurrent and metastatic prostate cancer (PCa). Based on the accuracy and sensitivity of early assays (c. 1960-1970), the castrate testosterone level was set at ≤1.7 nmol/l. Improved sensitivity of testosterone assays shows that both surgical and medical castration can achieve levels <0.7 nmol/l. However, the clinical implications and importance of maximum testosterone suppression remains a subject of controversy. This evidence-based review assesses prospective and retrospective clinical data, linking maximum suppression of testosterone with improved outcomes from ADT.
METHODS
PubMed and conference proceedings were searched for studies assessing the impact of low testosterone on clinical outcomes from ADT. The key search terms included combinations of prostate cancer and testosterone, predictive/prognostic, and androgen deprivation. Results were limited to studies investigating the relationship between testosterone levels and clinical outcomes.
RESULTS
Both prospective and retrospective data support a relationship between testosterone levels below the historical standard of 1.7 nmol/l and improved outcomes. Eight studies showed significant improvements in survival-related outcomes, with the majority of data supporting a testosterone level cutoff of ≤0.7 nmol/l.
CONCLUSIONS
Tracking both testosterone and prostate-specific antigen (PSA) levels has significant clinical benefits, and the serum testosterone threshold of ≤0.7 nmol/l is a practical goal. The relative levels of testosterone and PSA may indicate continued hormone responsiveness or progression toward castration-resistant prostate cancer (CRPC) and should, therefore, inform treatment strategy. Standardization of assay methods and clinical coordination to facilitate widespread access to state-of the art laboratory equipment is necessary to ensure accurate decision-making.
引言
睾酮抑制，即雄激素剥夺疗法（ADT），是复发性和转移性前列腺癌（PCa）的既定治疗方法。根据早期检测（约1960 - 1970年）的准确性和敏感性，去势睾酮水平设定为≤1.7 nmol/l。睾酮检测灵敏度的提高表明，手术去势和药物去势均可达到<0.7 nmol/l的水平。然而，最大程度睾酮抑制的临床意义和重要性仍是一个有争议的话题。本循证综述评估了前瞻性和回顾性临床数据，将睾酮的最大抑制与ADT改善的预后联系起来。
方法
检索PubMed和会议论文集，查找评估低睾酮对ADT临床结局影响的研究。关键检索词包括前列腺癌与睾酮的组合、预测/预后以及雄激素剥夺。结果仅限于研究睾酮水平与临床结局之间关系的研究。
结果
前瞻性和回顾性数据均支持低于1.7 nmol/l的历史标准的睾酮水平与改善的预后之间存在关联。八项研究显示生存相关结局有显著改善，大多数数据支持睾酮水平临界值≤0.7 nmol/l。
结论
同时追踪睾酮和前列腺特异性抗原（PSA）水平具有显著的临床益处，血清睾酮阈值≤0.7 nmol/l是一个切实可行的目标。睾酮和PSA的相对水平可能表明激素持续反应性或向去势抵抗性前列腺癌（CRPC）进展，因此应指导治疗策略。为确保准确决策，有必要对检测方法进行标准化并进行临床协调，以促进广泛使用先进的实验室设备。
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