An update on androgen deprivation therapy for prostate cancer.
An update on androgen deprivation therapy for prostate cancer.
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DOI：
10.1677/erc-10-0187
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发表时间：
2010-12
影响因子：
3.9
通讯作者：
Dahut WL
中科院分区：
文献类型：
--
作者：
Sharifi N;Gulley JL;Dahut WL
雄激素剥夺疗法（ADT）结合性腺睾酮减少是晚期前列腺癌的一线治疗方法。其他激素干预在前列腺癌的治疗中也有作用。我们试图系统地研究激素干预前列腺癌、ADT风险和减轻这些风险的干预措施的证据。PubMed和Web of Science检索了1966年至2010年2月期间使用前列腺癌、雄激素剥夺疗法和激素治疗等术语的英文文章。还审查了选定文章的参考书目和会议摘要。强调最高质量的数据。治疗性研究的结果主要集中在随机对照临床试验上，并使用Jadad量表标准来评估这些研究的质量。我们纳入了四项间歇ADT与连续ADT疗效的试验。一项随机研究分析和6项后随机分析纳入了ADT对心血管死亡率的影响。七项随机对照试验纳入药物干预治疗ADT引起的代谢影响。纳入了一项促性腺激素释放激素（GnRH）拮抗剂与GnRH激动剂的随机试验。包括六项具有新作用机制的二次激素治疗的I/II期临床试验。迄今为止完成的随机研究表明，间歇性ADT可能等同于连续ADT。虽然ADT的不良反应包括心血管疾病的危险因素，但对心血管死亡率的影响尚不确定。骨质流失和骨折风险增加可通过药物干预有效治疗。ADT的好处必须与风险的考虑相平衡。
Androgen deprivation therapy (ADT) with gonadal testosterone depletion is the frontline treatment for advanced prostate cancer. Other hormonal interventions have a role in the treatment of prostate cancer. We sought to examine systematically the evidence for hormonal interventions in prostate cancer, risks of ADT and interventions that mitigate these risks. PubMed and Web of Science were searched for English-language articles using the terms prostate cancer, androgen deprivation therapy and hormone treatment between 1966 and February 2010. Bibliographies from selected articles and meeting abstracts were also reviewed. The highest quality data was emphasized. Results for therapeutic studies were focused primarily on randomized controlled clinical trials and the Jadad scale criteria was used to evaluate the quality of these studies. Four trials of the efficacy of intermittent versus continuous ADT were included. One randomized study analysis and 6 postrandomization analyses were included on the effects of ADT on cardiovascular mortality. Seven randomized controlled trials were included of pharmacologic interventions for the treatment of metabolic effects due to ADT. One randomized trial of gonadotropin-releasing hormone (GnRH)-antagonist versus GnRH-agonist was included. Six phase I/II clinical trials of secondary hormonal therapies with novel mechanisms of action were included. Randomized studies completed to date indicate that intermittent might be equivalent to continuous ADT. Although adverse effects of ADT include risk factors for cardiovascular disease, effects on cardiovascular mortality are uncertain. Bone loss and increased risk of fracture may be effectively treated with pharmacologic interventions. Benefits of ADT must be balanced with a consideration of the risks.