Gonzalez-Barcena D, Vadillo-Buenfil M, Cortez-Morales A, Fuentes-Garcia M, Cardenas-Cornejo I, Comaru-Schally A M, Schally A V
Hospital de Especialidades, Centro Medico La Raza, IMSS, Mexico.
Urology. 1995 Feb;45(2):275-81. doi: 10.1016/0090-4295(95)80018-2.
To assess the clinical response to luteinizing hormone-releasing hormone (LH-RH) antagonist cetrorelix (SB-75) in patients with advanced carcinoma of the prostate and paraplegia due to metastatic invasion of spinal cord.
Cetrorelix was given at two different dose regimens to 5 patients with prostatic cancer Stage D2 and paraplegia. Urologic and neurologic examinations, laboratory studies, radiography (myelography), and prostate ultrasonography were carried out. Prostate-specific antigen (PSA) and free testosterone were also measured.
In all patients, the neurologic symptoms regressed. The recovery of the thermic and vibratory sensation and motility of the toes was observed. The neurologic improvement continued during the treatment and at 3 months all the patients were able to walk with the aid of a cane. In 1 patient, the myelography showed that the spinal cord compression had disappeared and prostate volume assessed by ultrasonography showed a significant decrease. The bladder function greatly improved in all 5 patients during the treatment with cetrorelix. Baseline levels of luteinizing hormone fell from 9.28 to 1.0 IU/L and those of follicle-stimulating hormone (FSH) fell from 18.28 to 12 IU/L (P < 0.05) after the first day of therapy with cetrorelix. Mean levels of free testosterone were reduced from 52.4 to 14.7 pmol/L (P < 0.005) at 12 hours and to 13.1 pmol/L (P < 0.005) 3 days after the first injection of cetrorelix. A persistent inhibition of gonadotropins and testosterone was maintained during the subsequent 3 months of therapy. The high levels of PSA gradually decreased.
Our results show that LH-RH antagonist cetrorelix causes an immediate lowering of the serum testosterone levels in patients with prostate cancer and metastases in the spinal cord, in whom the LH-RH agonists cannot be used as single drugs because of the possibility of flare-up and appears to be appropriate for long-term therapy.
评估促黄体生成激素释放激素（LH-RH）拮抗剂西曲瑞克（SB-75）对晚期前列腺癌伴脊髓转移瘤所致截瘫患者的临床疗效。
将西曲瑞克以两种不同剂量方案给予5例D2期前列腺癌伴截瘫患者。进行了泌尿外科和神经科检查、实验室研究、影像学检查（脊髓造影）以及前列腺超声检查。还测定了前列腺特异性抗原（PSA）和游离睾酮。
所有患者的神经症状均有改善。观察到足部温度觉、振动觉及运动功能恢复。治疗期间神经功能持续改善，3个月时所有患者均可借助拐杖行走。1例患者脊髓造影显示脊髓压迫消失，超声检查评估的前列腺体积显著减小。5例患者在接受西曲瑞克治疗期间膀胱功能均有显著改善。西曲瑞克治疗第1天后，促黄体生成素基线水平从9.28降至1.0 IU/L，促卵泡生成素（FSH）基线水平从18.28降至12 IU/L（P<0.05）。首次注射西曲瑞克12小时后游离睾酮平均水平从52.4降至14.7 pmol/L（P<0.005），3天后降至13.1 pmol/L（P<0.005）。在随后3个月的治疗期间，促性腺激素和睾酮持续受到抑制。高水平的PSA逐渐下降。
我们的结果表明，LH-RH拮抗剂西曲瑞克可使前列腺癌伴脊髓转移患者的血清睾酮水平立即降低，对于因可能出现“flare-up”现象而不能单独使用LH-RH激动剂的此类患者，西曲瑞克似乎适用于长期治疗。
