Department of Medicine and Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA.
Department of Urology, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA.
Medicina (Kaunas). 2024 Oct 22;60(11):1727. doi: 10.3390/medicina60111727.
Androgen deprivation therapy (ADT) is a mainstay treatment for metastatic prostate cancer, improving progression-free survival. ADT suppresses the production of testosterone and reduces circulating levels of the hormone. Luteinizing hormone-releasing hormone (LH-RH) agonists are the most commonly used ADT modality. They can be given alone or in combination with androgen synthesis inhibitors or androgen receptor antagonists. An estimated 40% of prostate cancer patients will receive ADT as part of their therapy during their lifetime. However, ADT has numerous adverse effects, including an increased cardiovascular risk that impacts quality of life. Relugolix is an alternative form of ADT. It is the only oral gonadotropin-releasing hormone antagonist, circumventing injection site reactions, making it easier for patients to take, and thus increasing compliance. Testosterone suppression with relugolix is excellent and testosterone recovery after discontinuation is rapid. This paper reviews the ADT and anti-androgen treatment options for men with prostate cancer and the cardiovascular effects of these therapies. There is accumulating evidence that cardiovascular risk with relugolix is lower than with other ADT medications and also lower than with androgen synthesis inhibitors and androgen receptor antagonists. This paper provides insight into the use of different ADT regimens based on the cardiovascular status and circumstances. It explores strategies to mitigate negative cardiovascular consequences and highlights the need for further study.
雄激素剥夺疗法（ADT）是转移性前列腺癌的主要治疗方法，可改善无进展生存期。ADT 抑制睾酮的产生并降低激素的循环水平。促黄体生成素释放激素（LH-RH）激动剂是最常用的 ADT 方式。它们可以单独使用或与雄激素合成抑制剂或雄激素受体拮抗剂联合使用。估计有 40%的前列腺癌患者在其一生中会接受 ADT 作为其治疗的一部分。然而，ADT 有许多不良反应，包括增加心血管风险，影响生活质量。瑞戈非尼是 ADT 的另一种形式。它是唯一的口服促性腺激素释放激素拮抗剂，避免了注射部位反应，使患者更容易服用，从而提高了依从性。瑞戈非尼对睾酮的抑制作用非常出色，停药后睾酮恢复迅速。本文回顾了前列腺癌男性的 ADT 和抗雄激素治疗选择以及这些治疗的心血管效应。有越来越多的证据表明，瑞戈非尼的心血管风险低于其他 ADT 药物，也低于雄激素合成抑制剂和雄激素受体拮抗剂。本文根据心血管状况和情况，深入探讨了不同 ADT 方案的使用。它探讨了减轻负面心血管后果的策略，并强调了进一步研究的必要性。
