Schlegel P N
Department of Urology, New York Hospital-Cornell Medical Center, New York.
Adv Intern Med. 1994;39:569-601.
A variety of new pharmacologic agents has allowed expanded therapeutic options for men with benign prostatic hypertrophy as well as men with prostate cancer. Appropriate implementation of these agents requires an understanding of their mechanisms of action, as well as awareness of the underlying pathological processes. Medical therapy of BPH is less invasive than standard surgical intervention, but it carries the risks of missing clinically significant prostate cancers. In addition, medical treatment of BPH is less effective than prostatectomy; however, since symptomatic relief is usually the end point of treatment for BPH, medical therapy is successful for many men without the risks of surgery. The GnRH agonists (and GnRH antagonists to be developed) allow medical hormonal therapy to be implemented for men with symptomatic prostate cancer without the psychological effects of castration. Oral antiandrogens allow for a prompt blockade of androgen action on prostate cancer during GnRH agonist use, and they may improve longevity for some men with prostate cancer. The widespread use of these agents should be tempered by their relatively high costs with long-term use.
多种新型药物制剂为患有良性前列腺增生的男性以及前列腺癌患者提供了更多的治疗选择。合理使用这些药物需要了解其作用机制以及潜在的病理过程。良性前列腺增生的药物治疗比标准手术干预侵入性小，但存在漏诊具有临床意义的前列腺癌的风险。此外，良性前列腺增生的药物治疗效果不如前列腺切除术；然而，由于症状缓解通常是良性前列腺增生治疗的终点，药物治疗对许多男性来说是成功的，且没有手术风险。促性腺激素释放激素（GnRH）激动剂（以及即将研发的GnRH拮抗剂）使有症状的前列腺癌男性能够接受药物激素治疗，而不会产生去势的心理影响。口服抗雄激素药物可在使用GnRH激动剂期间迅速阻断雄激素对前列腺癌的作用，并且可能延长一些前列腺癌男性的寿命。这些药物的广泛使用应因其长期使用成本相对较高而受到限制。
