Dhondt Bert, Buelens Sarah, Van Besien Jeroen, Beysens Matthias, De Bleser Elise, Ost Piet, Lumen Nicolaas
Department of Urology, Ghent University Hospital , Ghent , Belgium.
Department of Radiation Oncology and Experimental Cancer Research, Laboratory of Experimental Cancer Research, Ghent University , Ghent , Belgium.
Acta Clin Belg. 2019 Dec;74(6):439-444. doi: 10.1080/17843286.2018.1543827. Epub 2018 Nov 26.
Disease progression in metastatic castration-resistant prostate cancer (mCRPC) is dependent on androgen signaling. This case describes the complex adaptive androgen signaling mechanisms in mCRPC and illustrates that caution should be exercised when treating these patients with drugs influencing the androgen axis. Single case report and review of the literature. We report the case of an 86-year-old man with mCRPC, treated with the secondary antihormonal agent abiraterone acetate. Following association of spironolactone to deal with symptoms related to mineralocorticoid excess, biochemical and radiographic disease progression occurred. Spironolactone was discontinued and 8 months after withdrawal, the patient continues to show a biochemical response to abiraterone. Although spironolactone generally exerts anti-androgenic effects, experimental evidence exists that it acts as an androgen receptor agonist in an androgen-depleted environment, capable of inducing prostate cancer proliferation. This is supported by the observations described in this case report. Therefore, spironolactone should be avoided in prostate cancer patients suffering from treatment-associated side effects of abiraterone.
转移性去势抵抗性前列腺癌（mCRPC）的疾病进展依赖于雄激素信号传导。本病例描述了mCRPC中复杂的适应性雄激素信号传导机制，并表明在使用影响雄激素轴的药物治疗这些患者时应谨慎。单病例报告及文献综述。我们报告了一例86岁患有mCRPC的男性患者，接受二线抗激素药物醋酸阿比特龙治疗。在联合使用螺内酯以处理与盐皮质激素过多相关的症状后，出现了生化和影像学疾病进展。停用螺内酯，停药8个月后，患者对阿比特龙仍表现出生化反应。虽然螺内酯通常发挥抗雄激素作用，但有实验证据表明，在雄激素缺乏的环境中它可作为雄激素受体激动剂，能够诱导前列腺癌增殖。本病例报告中的观察结果支持了这一点。因此，患有阿比特龙治疗相关副作用的前列腺癌患者应避免使用螺内酯。
