Costello Leslie C, Franklin Renty B, Yu George W
Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, and The University of Maryland Greenebaum Comprehensive Cancer Center. Baltimore, Maryland. 21201 USA.
Department of Urology; George Washington University School of Medicine; 2300 East Street, NW, Washington, DC. 20037 USA.
Mathews J Case Rep. 2019;4(1). Epub 2019 May 8.
Testosterone promotes the initial development of androgen-dependent prostate cancer. This is the basis for androgen ablation treatment, which attenuates, but does not terminate, the malignancy. Instead, it leads to prolactin-dependent malignancy; in which patient death generally occurs within 5 years. This report describes the novel treatment of a patient; which terminated androgen-independent prostate cancer.
Patient "XY" was diagnosed with prostate malignancy and metastases. He received hormonal androgen ablation treatment, chemotherapy, and radiation treatment. He developed androgen-independent prostate cancer; with expected death in 2-3 years. He was treated with cabergoline (dopamine agonist) treatment, which decreased the plasma prolactin 88%; by inhibiting the pituitary production of prolactin. The subsequent PET scan (positron emission tomography) revealed the absence of malignancy; and the CTC (circulating tumor cells) decreased from count=5.4 to count=0.
The cause of androgen-independent malignancy has been unknown, and an effective chemotherapy did not exist. The activities of normal and malignant prostate cells are regulated primarily by testosterone. When testosterone availability diminishes; prolactin regulation is manifested. This is represented when androgen ablation results in the development of prolactin-dependent malignancy. An effective chemotherapy would be targeted to eliminate the plasma prolactin-manifestation of the androgen-independent malignancy.
This report of a novel chemotherapy for androgen-independent malignancy corroborates our understanding of the implications of prolactin in its development and treatment. There are about 165,000 cases/year with 25,000 deaths/year in the U.S.; and 1.0 million cases/year with 260,000 deaths/year worldwide. Those patients with androgen-independent prostate cancer can now employ this cabergoline treatment to prevent or terminate this deadly type of prostate cancer.
睾酮促进雄激素依赖性前列腺癌的初始发展。这是雄激素剥夺治疗的基础,该治疗可减轻但不能终止恶性肿瘤。相反,它会导致催乳素依赖性恶性肿瘤;患者通常在5年内死亡。本报告描述了对一名患者的新治疗方法;该方法终止了雄激素非依赖性前列腺癌。
患者“XY”被诊断患有前列腺恶性肿瘤并伴有转移。他接受了激素雄激素剥夺治疗、化疗和放射治疗。他发展为雄激素非依赖性前列腺癌;预计在2 - 3年内死亡。他接受了卡麦角林(多巴胺激动剂)治疗,通过抑制垂体分泌催乳素,使血浆催乳素降低了88%。随后的PET扫描(正电子发射断层扫描)显示无恶性肿瘤;循环肿瘤细胞(CTC)计数从5.4降至0。
雄激素非依赖性恶性肿瘤的病因一直不明,且不存在有效的化疗方法。正常和恶性前列腺细胞的活动主要由睾酮调节。当睾酮可用性降低时;催乳素调节就会显现。雄激素剥夺导致催乳素依赖性恶性肿瘤的发展就体现了这一点。有效的化疗应旨在消除雄激素非依赖性恶性肿瘤的血浆催乳素表现。
这份关于雄激素非依赖性恶性肿瘤新化疗方法的报告证实了我们对催乳素在其发展和治疗中的影响的理解。在美国,每年约有16.5万例病例,2.5万人死亡;在全球,每年有100万例病例,26万人死亡。那些患有雄激素非依赖性前列腺癌的患者现在可以采用这种卡麦角林治疗来预防或终止这种致命的前列腺癌类型。