Failure to achieve castrate level of serum testosterone during luteinizing hormone-releasing hormone agonist therapy in a patient with prostate cancer.
Failure to achieve castrate level of serum testosterone during luteinizing hormone-releasing hormone agonist therapy in a patient with prostate cancer.
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DOI：
10.1097/cad.0000000000000986
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发表时间：
2020-11
影响因子：
2.3
通讯作者：
Uemura M
中科院分区：
文献类型：
--
作者：
Koh Y;Kawashima A;Ujike T;Nagahara A;Fujita K;Kiuchi H;Imamura R;Miyagawa Y;Nonomura N;Uemura M
我们报告了一名前列腺癌患者在黄体生成素释放激素激动剂治疗期间未能达到去势血清睾酮水平。一名76岁男性于2011年8月因血清前列腺特异性抗原（PSA）水平升高（191.10 ng/ml）入院，诊断为T3aN0M1b前列腺腺癌。使用黄体生成素释放激素激动剂（醋酸亮丙瑞林的 1 个月长效制剂）和抗雄激素联合进行雄激素阻断。由于肝功能障碍，停用抗雄激素药物（比卡鲁胺和氟他胺）。 2013年5月，1个月的储存期改为3个月的储存期，但患者主诉感染部位出现硬结和脓肿。醋酸亮丙瑞林被醋酸戈舍瑞林替代。由于注射醋酸戈舍瑞林1个月长效制剂后未出现不良事件，因此于2013年10月注射3个月长效制剂。PSA水平逐渐升高，睾酮水平大于50 ng/dl，即高于去势范围。为期 3 个月的醋酸亮丙瑞林和醋酸戈舍瑞林对该患者均无效。因此，开始使用醋酸亮丙瑞林 1 个月，导致 PSA 和睾酮水平迅速下降。此后，可以继续雄激素剥夺治疗。雄激素剥夺疗法是晚期前列腺癌患者的标准治疗方法，黄体生成素释放激素旨在将血清睾酮抑制至去势范围。我们建议在黄体生成素释放激素激动剂治疗期间评估血清睾酮水平，以监测治疗效果并在 PSA 水平升高时验证病情进展。
We report the failure to achieve castrate level of serum testosterone during luteinizing hormone-releasing hormone agonist therapy in a patient with prostate cancer. A 76-year-old man was admitted to our hospital for evaluation of an elevated serum prostate specific antigen (PSA) level (191.10 ng/ml) in August 2011. He was diagnosed with T3aN0M1b prostate adenocarcinoma. A combined androgen blockade using luteinizing hormone-releasing hormone agonist (the 1-month depot of leuprorelin acetate) and antiandrogen was administered. Due to liver dysfunction, antiandrogens, both bicalutamide and flutamide, were stopped. The 1-month depot was switched to the 3-month depot in May 2013, but the patient complained of induration and abscess at the infection site. Leuprorelin acetate was replaced by goserelin acetate. Because no adverse event appeared after injection of the 1-month depot of goserelin acetate, the 3-month depot was administered in October 2013. The PSA level increased gradually, and the testosterone level was greater than 50 ng/dl, that is, above castrate range. The 3-month depot of both leuprorelin acetate and goserelin acetate was not effective for this patient. For this reason, the 1-month depot of leuprorelin acetate was started resulting in a rapid decrease in PSA and testosterone levels. Thereafter, androgen depriving therapy could be continued. Androgen deprivation therapy is the standard treatment for patients with advanced prostate cancer and luteinizing hormone-releasing hormone aims to suppress serum testosterone to castrate range. We recommend assessing the serum testosterone levels during luteinizing hormone-releasing hormone agonist therapy for monitoring treatment efficacy and verifying progression when the PSA level increases.