Medical adrenalectomy for advanced prostatic cancer: clinical and hormonal effects.
Medical adrenalectomy for advanced prostatic cancer: clinical and hormonal effects.
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晚期前列腺癌的医学肾上腺切除术：临床和激素影响。
DOI：
10.1097/00000421-198810000-00014
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Szmal,E
中科院分区：
文献类型：
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作者：
Samojlik,E;Lippman,AJ;Kirschner,MA;Ertel,NH;Park,Y;Szmal,E
我们研究了药物肾上腺切除术对50例播散性前列腺癌患者的临床和激素反应的影响。对初始激素治疗难治的患者用氨鲁米特和氢化可的松（AG-HC）治疗，并根据国家前列腺癌项目的标准进行评估。8名患者显示部分反应（PR），17名患者在接受这些药物治疗时保持稳定。这两组的平均生存时间分别为87.8周和38周。相比之下，17名男性对这种疗法没有反应，表现出疾病进展，平均生存时间为18周。8例患者不能耐受药物治疗方案或失访。在AG-HC治疗期间连续测定的血清和尿激素谱显示，AG-HC治疗显著降低了所有测量的血清雄激素和雌激素;然而，与无应答者（NR）相比，应答者（R）中特定激素（包括游离睾酮、双氢睾酮、雌酮和雌二醇）受到更大程度的抑制。在AG-HC治疗期间，17-酮类类固醇的尿排泄没有变化，但特定的雄激素代谢产物，包括睾酮葡糖苷酸和雄甾烷葡糖苷酸，在AG-HC治疗期间被抑制了50%。我们显示AG-HC治疗晚期前列腺癌的适度临床获益。更大的激素抑制与对这种治疗的更大反应性相关，这提出了进一步针对睾丸外雄激素抑制的操作可能是晚期前列腺癌二线治疗的有用方法的希望。
We examined the effect of medical adrenalectomy on the clinical and hormonal responses in 50 men with disseminated prostatic carcinoma. Patients refractory to initial hormonal therapy were treated with aminoglutethimide and hydrocortisone (AG-HC) and evaluated by the criteria of the National Prostatic Cancer Project. Eight patients showed a partial response (PR), and 17 remained stable while receiving these medications. Survival times for these two groups averaged 87.8 and 38 weeks, respectively. In contrast, 17 men were unresponsive to this therapy, exhibiting progressive disease with a mean survival time of 18 weeks. Eight patients could not tolerate the drug regimen or were lost to follow-up. Serum and urinary hormone profiles determined serially during AG-HC therapy revealed that all measured serum androgens and estrogens were significantly lowered by AG-HC treatment; however, specific hormones, including free testosterone, di-hydrotesterone, estrone, and estradiol were suppressed to a greater degree in responders (R) as compared with nonresponders (NR). Urinary excretion of 17-ketosteroids did not change during AG-HC therapy, but specific androgen metabolites, including testosterone glucuronide and androstanediol glucuronide, were suppressed by 50% during AG-HC therapy. We showed modest clinical benefit of AG-HC therapy in advanced prostatic cancer. That greater hormonal suppression was associated with greater responsiveness to this therapy raises the hope that further manipulations directed against suppression of extratesticular androgens may be a useful approach as second-line treatment of advanced prostatic cancer.