[Androgen-deprivation therapy in prostate cancer: clinical evidence and future perspectives].
Androgens are involved in the development and progression of prostate cancer even if the mechanism is not well-recognized. For this reason androgen-deprivation therapy remains a milestone for the treatment of patients with advanced and metastatic disease and, in the last years, in conjunction with radiotherapy and surgery in locally advanced tumors. Alternative options, such as intermittent deprivation suppression, seem to be promising in terms of clinical benefits and toxicity profile. However, current therapies present side effects, such as testosterone surge with consequent clinical flare-up, metabolic syndrome and hormone-resistance, which develops after a variable number of years. Novel therapies such as LH-RH antagonists and prolonged depot LH-RH analogues have been developed in order to avoid clinical flare-up and testosterone microsurges. Novel androgen synthesis inhibitors, such as abiraterone acetate and MDV3100, have been recently discovered and tested as promising hormonal second-line agents in patients with castration-resistant prostate cancer. Finally, long-term side effects from androgen deprivation, such as osteoporosis, sarcopenic obesity and cardiovascular morbidity should be carefully monitored and properly treated.
Pinto
F
F
Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma. francesco.pinto@libero.it
Calarco
A
A
Totaro
A
A
Sacco
E
E
Volpe
A
A
Racioppi
M
M
D'Addessi
A
A
Bassi
P F
PF
D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000230:Adenocarcinoma / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000728:Androgens / Q000502:physiology; D000736:Androstenes; D000737:Androstenols / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D001549:Benzamides; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005262:Feminization / Q000139:chemically induced; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors*; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009363:Neoplasm Proteins / Q000187:drug effects / Q000502:physiology; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000628:therapy; D009570:Nitriles; D009919:Orchiectomy; D010669:Phenylthiohydantoin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D011944:Receptors, Androgen / Q000187:drug effects / Q000502:physiology; D013739:Testosterone / Q000037:antagonists & inhibitors / Q000096:biosynthesis / Q000378:metabolism
D058891:5-alpha Reductase Inhibitors; D000726:Androgen Antagonists; D000728:Androgens; D000736:Androstenes; D000737:Androstenols; D018931:Antineoplastic Agents, Hormonal; D001549:Benzamides; D009363:Neoplasm Proteins; D009570:Nitriles; D011944:Receptors, Androgen; D010669:Phenylthiohydantoin; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; C540278:enzalutamide; C089740:abiraterone