Moorthy H Krishna, Laxman Prabhu G G, Venugopal P
Department of Urology, Lourdes Hospital, Kochi, Kerala, India.
Department of Urology, Kasturba Medical College (A Unit of Manipal Academy of Higher Education), Mangalore, Karnataka, India.
Indian J Urol. 2019 Jul-Sep;35(3):189-196. doi: 10.4103/iju.IJU_56_19.
Use of exogenous estrogens in manipulating the androgenestrogen equilibrium was one of the earliest therapeutic strategies developed to treat prostate cancer which followed close on heels the discovery of hormone dependence of this tumor. Despite its well-documented benefit, estrogen therapy fell out of favor with the advent of other forms of androgen deprivation therapy (ADT) as the former registered a higher incidence of cardiovascular complications and poorer overall survival. Clearer understanding of the mechanism of action of estrogen coupled with the adoption of alternative routes of administration has triggered a renewed interest in estrogen therapy. Since then, many studies have not only proved the therapeutic benefit of estrogens but also explored the ways and means of minimizing the dreaded side effects deterring its use. Further, the fact that estrogen therapy offered a clear advantage of reduced cost of treatment over other treatments has led many countries to readopt it in the treatment of advanced prostatic cancer. We reviewed the published data on the use of estrogens in CRPC, which may affect its revival as an efficacious treatment option having minimal side effects, with modified dosage and route of administration. Estrogen therapy would be a less expensive option having equivalent or even better therapeutic effect than ADT in advanced carcinoma of prostate.
利用外源性雌激素来调控雄激素 - 雌激素平衡是最早开发的治疗前列腺癌的策略之一，紧随该肿瘤激素依赖性的发现之后。尽管雌激素疗法的益处有充分记录，但随着其他形式的雄激素剥夺疗法（ADT）的出现，雌激素疗法不再受青睐，因为前者心血管并发症的发生率更高且总体生存率更低。对雌激素作用机制的更清晰理解以及采用替代给药途径引发了对雌激素疗法的新兴趣。从那时起，许多研究不仅证明了雌激素的治疗益处，还探索了将阻碍其使用的可怕副作用降至最低的方法。此外，雌激素疗法在治疗成本方面相对于其他治疗方法具有明显优势，这使得许多国家重新采用它来治疗晚期前列腺癌。我们回顾了已发表的关于雌激素在去势抵抗性前列腺癌（CRPC）中应用的数据，这些数据可能会影响其作为一种副作用最小、剂量和给药途径经过改良的有效治疗选择的复兴。雌激素疗法在晚期前列腺癌中是一种成本较低的选择，其治疗效果与ADT相当甚至更好。
