Hormonal therapy of prostate cancer.
In the 60 years since Huggins first demonstrated the hormone dependency of prostate cancer, the introduction of various means of hormonal manipulation has resulted in modest achievements. Orchiectomy reduced testosterone but was irreversible and associated with reduced quality of life. Diethylstilbestrol (DES) represented the first alternative to surgical castration. However, cardiovascular adverse events severely limited its use. The luteinizing hormone-releasing hormone (LHRH) agonists offered true medical castration but suffered from problems of testosterone surge and tumor flare. The introduction of antiandrogens in combination with LHRH agonists appears on meta-analysis not to have improved survival and has implications for the cost and convenience of therapy, as well as added toxicity. Gonadotropin-releasing hormone (GnRH) antagonists offer for the first time a truly rapid medical means of reducing testosterone and also suppress follicle-stimulating hormone (FSH). However, the clinical benefit of this new class of drugs remains to be evaluated.
Department of Urology, University Hospital Nijmegen, Nijmegen, The Netherlands.
Frans
F
Debruyne
D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D004054:Diethylstilbestrol / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008297:Male; D009842:Oligopeptides / Q000627:therapeutic use; D009919:Orchiectomy; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000628:therapy*; D013739:Testosterone / Q000097:blood
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D009842:Oligopeptides; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D004054:Diethylstilbestrol; D017430:Prostate-Specific Antigen; D016729:Leuprolide; C423508:abarelix