Byar D P, Corle D K
Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, MD 20892.
NCI Monogr. 1988(7):165-70.
Between 1960 and 1975, the Veterans Administration Cooperative Urological Research Group conducted a consecutive series of 3 major randomized clinical trials comparing various endocrine treatments for newly diagnosed prostate cancer patients. Six major conclusions concerning hormonal treatment emerged from these studies: 1) increased hazard of cardiovascular death after therapy with 5 mg diethylstilbestrol (DES); 2) orchiectomy plus DES no better than orchiectomy or DES alone; 3) equivalent effect of 1.0 and 5.0 mg DES on cancer; 4) reduced cardiovascular hazard from therapy with 1.0 mg DES; 5) Premarin and Provera no better than 1.0 mg DES at doses studied; 6) decisions about hormone treatment at diagnosis dependent on patient characteristics, mainly age and Gleason grade. In this paper, these studies are reviewed briefly and data are presented to support these conclusions. Some tentative treatment recommendations are proposed.
1960年至1975年间，退伍军人管理局合作泌尿学研究小组连续开展了3项主要的随机临床试验，比较了针对新诊断前列腺癌患者的各种内分泌治疗方法。这些研究得出了关于激素治疗的6个主要结论：1）使用5毫克己烯雌酚（DES）治疗后心血管死亡风险增加；2）睾丸切除术加DES并不比单纯睾丸切除术或DES更好；3）1.0毫克和5.0毫克DES对癌症的疗效相当；4）使用1.0毫克DES治疗可降低心血管风险；5）在研究剂量下，普雷马林和安宫黄体酮并不比1.0毫克DES更好；6）诊断时关于激素治疗的决策取决于患者特征，主要是年龄和 Gleason分级。本文简要回顾了这些研究，并给出数据以支持这些结论。还提出了一些初步的治疗建议。
