前列腺癌激素治疗

概述

前列腺癌激素治疗是一种阻止激素睾酮产生或到达前列腺癌细胞的疗法。

大多数前列腺癌细胞依靠睾酮才能生长。激素治疗可使前列腺癌细胞死亡或生长缓慢。

前列腺癌激素治疗可能包括药物治疗或手术切除睾丸。

前列腺癌激素治疗也称为雄激素剥夺疗法。

Types

Types of hormone therapy for prostate cancer include:

• Medicines that stop the body from making testosterone. Some medicines block signals that tell the testicles to make testosterone. These medicines are called luteinizing hormone-releasing hormone (LHRH) agonists and antagonists. Another name for them is gonadotropin-releasing hormone (GnRH) agonists and antagonists.
• Medicines that block the action of testosterone in the body. These medicines are known as antiandrogens. They're often used with LHRH agonists. That's because LHRH agonists can cause a brief rise in testosterone levels before testosterone levels go down.
• Surgery to remove the testicles. This surgery is called an orchiectomy. It lowers testosterone levels in the body quickly. In some cases, only the part of the testicles that makes testosterone is removed. Both procedures are permanent.

In the form of medicine, hormone therapy for prostate cancer, also called ADT, can be given all the time or off and on:

• Continuous ADT is given without stopping.
• Intermittent ADT is given for a set amount of time or until a prostate-specific antigen (PSA) test shows a low number. This test measures a protein produced by both cancerous and noncancerous tissue in the prostate. If the number is low, the treatment is paused. If the cancer comes back or gets worse, the treatment may start again.

Some early studies show that intermittent ADT may cause fewer side effects and still work just as well as continuous ADT for some people. It also might help them feel better day to day.

目的

前列腺癌激素治疗可用于阻断体内的睾酮激素。睾酮可促进前列腺癌细胞的生长。

在癌症治疗的不同阶段和不同情况下，前列腺癌激素治疗都可能是一个选择。

激素治疗可用于：

• 已经扩散的前列腺癌（转移性前列腺癌），以缩小肿瘤和减缓肿瘤的生长。该治疗还可能缓解症状。
• 前列腺癌治疗后，当前列腺特异性抗原（PSA）水平仍然很高或开始升高时。
• 局部晚期前列腺癌，以改善外照射疗法在降低癌症复发风险方面的效果。
• 降低癌症复发高危患者的癌症复发风险。

风险

前列腺癌激素治疗的副作用包括：

• 肌肉量减少。
• 体脂增加。
• 性欲丧失。
• 无法勃起或保持勃起，称为勃起功能障碍。
• 骨骼变薄，这可能导致骨折。
• 潮热。
• 毛发减少、生殖器变小、乳房组织生长。
• 疲倦。
• 糖尿病。
• 心脏病。

如何进行准备

如果您正在考虑接受前列腺癌激素治疗，请与医生讨论您的选择。前列腺癌激素治疗的类型包括：

• 通过药物阻止睾丸产生睾酮。某些药物会阻止细胞接收命令其产生睾酮的信号。这些药物称为促黄体素释放激素（LHRH）激动剂和拮抗剂。这些药物还有另一个名称，即促性腺激素释放激素激动剂和拮抗剂。
• 通过药物阻止睾酮作用于癌细胞。这些药物称为抗雄激素，通常联合 LHRH 激动剂使用。这是因为 LHRH 激动剂可能在睾酮水平降低之前导致睾酮水平短暂升高。
• 手术切除睾丸（睾丸切除术）。手术切除两侧睾丸可迅速降低体内的睾酮水平。这项医疗程序的一种做法是只切除产生睾酮的组织，而不切除睾丸。切除睾丸的手术无法逆转。

可能出现的情况

LHRH 促效剂和拮抗剂

LHRH 激动剂和拮抗剂药物可阻止睾丸产生睾酮。

这些药物大多通过皮下注射或肌肉注射的方式给药，每月、每三个月或每六个月给药一次。它们也可能作为植入剂植入皮肤下。这种植入剂会逐渐缓慢释放药物。

LHRH 激动剂包括：

• 亮丙瑞林（Eligard、Lupron Depot 等）。
• 戈舍瑞林（Zoladex）。
• 曲普瑞林（Trelstar）。

LHRH 拮抗剂包括：

• 地加瑞克（Firmagon）。
• 瑞卢戈利（Orgovyx）。

在接受 LHRH 激动剂后的几周内，睾酮水平可能会短期升高（激增）。LHRH 拮抗剂不会导致睾酮激增。

对于有疼痛或其他癌症症状的患者来说，降低睾酮激增的风险非常重要。睾酮升高可能使症状加重。在服用 LHRH 激动剂之前或同时服用抗雄激素可降低睾酮激增的风险。

抗雄激素

抗雄激素可阻止睾酮作用于癌细胞。这些口服药物通常与 LHRH 激动剂同时使用，或者在服用 LHRH 激动剂之前使用。

抗雄激素包括：

• 比卡鲁胺（Casodex）。
• 氟他胺。
• 尼鲁米特（Nilandron）。
• 阿帕他胺（Erleada）。
• 达罗他胺（Nubeqa）。
• 恩扎卢胺（Xtandi）。

睾丸切除术

极少使用这种切除睾丸的治疗方式。在对腹股沟部位实施麻醉后，外科医生会在腹股沟开口并经此取出一侧睾丸，然后对另一侧睾丸重复此过程。

所有手术都有疼痛、出血和感染的风险。大多数患者在做完此手术后即可回家。此手术通常不需要住院。

结果

如果您在接受前列腺癌激素治疗，需要定期复诊。医生可能询问您所经历的任何副作用。许多副作用是可以控制的。

医生可能安排一些检查以了解您的健康状况，并观察是否有癌症复发或恶化的迹象。这些检查的结果可以显示您对激素治疗的反应。必要时，可能会调整治疗方案。

Hormone therapy resistance

Over time, most prostate cancers eventually become resistant to ADT. This means the hormone therapy stops working. The cancer continues to grow even when testosterone levels are very low. You might hear this type of cancer called castration resistant, hormone resistant or androgen resistant. You also might hear it called hormone-refractory prostate cancer (HRPC).

It's difficult to predict how long until a prostate cancer becomes resistant to ADT. About half of those treated with ADT become resistant within 2 to 3 years. And about half become resistant after more than 2 to 3 years.

Your healthcare professional likely will order regular testing to check your health and to see if the cancer is coming back or getting worse. These tests can show your response to ADT.

If your cancer appears to become resistant, you generally continue taking hormone therapy. This is to keep testosterone levels low. If testosterone levels go up, it could make the cancer grow or get worse.

A healthcare professional may suggest a different hormone therapy. Or you might also be given another type of medicine, depending on your situation. Other medicines could include:

• Chemotherapy.
• A type of medicine that contains radioactive material, called a radiopharmaceutical.
• A type of medicine called a poly(ADP-ribose) polymerase (PARP) inhibitor. This could be an option if you have certain gene changes.
• A type of medicine that targets your immune system, called immunotherapy. This might be an option if you have a certain type of tumor.

Survival rates

How long someone lives with prostate cancer after starting hormone therapy can be different for each person. It depends on things like the stage of the cancer and how far it has spread. Your healthcare professional may be able to give you more exact information based on your condition.