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Ọgwụ Hormone maka Ọrịa Cancer
Kedu ihe bụ homonụ nwoke na nwanyị?
Hormones bụ ihe ndị glands na-arụ n’ahụ́ nke na-arụ ọrụ dịka akara kemịkal. Ha na-emetụta omume nke sel na anụ ahụ na ebe dị iche iche na ahụ, na-erukarị ihe ha chọrọ site na njem site n'ọbara.
Androgens (homonụ nwoke na nwanyị) bụ klas nke homonụ na-achịkwa mmepe na ndozi nke njirimara nwoke. Testosterone na dihydrotestosterone (DHT) bụ ọtụtụ androgens n'ime ụmụ nwoke. Ihe fọrọ nke nta ka ọ bụrụ testosterone niile ka a na-emepụta na testicles; a na-emepụta obere ego site na adrenal glands. Na mgbakwunye, ụfọdụ mkpụrụ ndụ kansa cancer na-enweta ikike iji testosterone sitere na cholesterol (1).
Kedu ka homonụ si akpali uto nke ọrịa kansa prostate?
A na-achọ Androgens maka uto na ọrụ nke prostate, gland na usoro ịmụ nwa nwoke nke na-enyere aka mee ka ọbara nwee ọbara. Androgens dịkwa mkpa maka ọrịa cancer prostate toro. Androgens na-akwalite uto nke mkpụrụ ndụ prostate nkịtị na nke nwere kansa site na ijikọ na ịgbalite androgen receptor, protein nke egosiri na mkpụrụ ndụ prostate (2). Ozugbo arụ ọrụ, androgen receptor na-akpali mkpesa okwu nke mkpụrụ ndụ ihe nketa ụfọdụ na - eme ka mkpụrụ ndụ prostate too (3).
Ná mmalite nke mmepe ha, ọrịa cancer prostate chọrọ ọkwa dị elu nke androgens ka ha too. A na-akpọ ọrịa cancer prostate dị otú ahụ castration sensitive, androgen dependent, or orrogen sensitive n'ihi na ọgwụgwọ ndị na-ebelata etrogen ogo ma ọ bụ na-egbochi orrogen ọrụ nwere ike igbochi uto ha.
Ọrịa prostate ejiri ọgwụ ma ọ bụ ịwa ahụ nke na-egbochi androgens mechara ghọọ castration (ma ọ bụ castrate) na-eguzogide ọgwụ, nke pụtara na ha nwere ike ịga n'ihu na-eto eto ọbụlagodi na etrogen etolite n'ime ahụ dị oke ala ma ọ bụ enweghị ike ịchọpụta. N'oge gara aga, a na-akpọkwa etuto ndị a hormone na-eguzogide ọgwụ, androgen nọọrọ onwe ha, ma ọ bụ ihe na-ajụ mmiri; Otú ọ dị, a naghị ejikarị okwu ndị a eme ihe ugbu a n'ihi na etuto ahụ aghọwo ihe na-eguzogide ọgwụ nwere ike ịzaghachi otu ma ọ bụ karịa n'ime ọgwụ antiandrogen ọhụrụ.
Kedu ụdị ọgwụgwọ hormone a na-eji maka ọrịa cancer prostate?
Hormone ọgwụgwọ maka ọrịa prostate nwere ike igbochi mmepụta ma ọ bụ ojiji nke androgens (4). Ọgwụgwọ ndị dị ugbu a nwere ike ịme ya n'ọtụtụ ụzọ:
- Ibelata mmeputa androgen site na testicles
- Na-egbochi omume nke androgens n'akụkụ ahụ niile
- Gbochie mmepụta androgen (njikọ) n’ime ahụ niile
Ọgwụ ndị na-ebelata mmepụta androgen site na nke testicles bụ ọgwụgwọ a na-ejikarị agwọ ọrịa cancer maka ọrịa prostate na ụdị ọgwụgwọ mbụ nke ọtụtụ ụmụ nwoke nwere ọrịa prostate na-enweta. Dị ọgwụgwọ a (nke a na-akpọkwa ọgwụgwọ androgen, ma ọ bụ ADT) gụnyere:
- Orchiectomy, usoro ịwa ahụ iji wepu otu ma ọ bụ abụọ testicles. Mwepụ nke testicles nwere ike belata ogo testosterone n'ime ọbara site na 90 ruo 95% (5). Typedị ọgwụgwọ a, nke a na-akpọ nkedo ịwa ahụ, na-adịgide adịgide ma bụrụ nke a na-apụghị ịgbanwe agbanwe. Typedị orchiectomy a na-akpọ subcapsular orchiectomy na-ewepu naanị anụ ahụ dị na testicles nke na-amịpụta androgens, karịa mpempe akwụkwọ dum.
- Ọgwụ akpọ akpọ luteinizing homonụ nke na - ahapụ onwe ya (LHRH) agonists, nke na - egbochi mmiri ọgwụ ana - akpọ hormone luteinizing. Ndị agonists LHRH, nke a na-akpọ LHRH analogs mgbe ụfọdụ, bụ protein na-emepụta sịntetik nke yiri nke LHRH ma jikọta ya na LHRH nnabata na pituitary gland. (LHRH makwaara dị ka gonadotropin na-ahapụ hormone ma ọ bụ GnRH, ya mere a na-akpọkwa agonists LHRH agonists GnRH.)
Dị ka ọ dị, mgbe etrogen na-arụ ọrụ na ahụ dị obere, LHRH na-akpali pituitary gland iji mepụta hormone luteinizing, nke n'aka nke ya na-akpali testicles iji mepụta androgens. Ndị agonists LHRH, dị ka LHRH nke ahụ, na-akpali akpali nke hormone luteinizing. Agbanyeghị, ọnụnọ dị elu nke agonists LHRH dị elu na-eme ka pituitary gland kwụsị imepụta homonụ luteinizing, na n'ihi ya, a naghị akpali mkpịsị aka iji mepụta androgens.
A na-akpọ ọgwụgwọ na agonist LHRH ọgwụ castration ma ọ bụ nkedo kemịkal n'ihi na ọ na-eji ọgwụ eme ihe otu ihe ahụ dị ka ịwa ahụ (orchiechtomy). Ma, n'adịghị ka orchiectomy, mmetụta nke ọgwụ ndị a na mmepụta androgen na-agbanwe agbanwe. Ozugbo ọgwụgwọ kwụsịrị, mmepụta androgen na-amalitekarị.
A na-enye ndị agonists LHRH site na ogwu ogbugba ma ọ bụ etinyere n'okpuru anụahụ. Anọ LHRH agonist anabatara na-agwọ ọrịa cancer prostate na United States: leuprolide, goserelin, triptorelin, na histrelin.
Mgbe ndị ọrịa natara agonist LHRH maka oge mbụ, ha nwere ike ịnwe ihe ọhụụ akpọrọ "testosterone flare." Ọganihu a na-adịru nwa oge na ọkwa testosterone na-eme n'ihi na LHRH agonists na-akpata nkenke oge ka pituitary gland zoo hormone luteinizing ọzọ tupu gbochie ntọhapụ ya. Ọkụ ahụ nwere ike njọ mgbaàmà ahụike (dịka ọmụmaatụ, mgbu ọkpụkpụ, ureter ma ọ bụ mgbochi eriri afọ, na mkpakọ ụdọ), nke nwere ike ịbụ nsogbu pụrụ iche na ụmụ nwoke nwere ọrịa cancer prostate dị elu. A na-egbochi mmụba nke testosterone site n'inye ụdị ọgwụgwọ ọzọ nke a na-akpọ ọgwụgwọ antiandrogen tinyere onye agonist LHRH maka izu ole na ole mbụ nke ọgwụgwọ.
- Ọgwụ a na-akpọ LHRH ndị na-emegide ya, nke bụ ụdị ọgwụgwọ ọzọ. Ndị na-emegide LHRH (nke a na-akpọkwa GnRH antagonists) na-egbochi LHRH ka ọ ghara ijikọta ndị nabatara ya na pituitary gland. Nke a na-egbochi secretion nke luteinizing hormone, nke na-egbochi testicles imepụta androgens. N'adịghị ka ndị agonists LHRH, ndị na-emegide LHRH anaghị akpata iwe ọkụ testosterone.
Otu onye na-emegide LHRH, degarelix, ka akwadoro ka ọ gwọọ ọrịa cancer prostate dị elu na United States. A na-enye ya site na ogwu ogbugba.
- Estrogens (homonụ nke na-akwalite njirimara nwanyị). Ọ bụ ezie na estrogens nwekwara ike igbochi mmeputa androgen site na testicles, a naghị ejikarị ya eme ihe taa n'ịgwọ ọrịa cancer prostate n'ihi mmetụta ha.
A na-ejikarị ọgwụgwọ na-egbochi ihe androgens na ahụ (nke a na-akpọkwa ọgwụgwọ antiandrogen) mgbe ADT kwụsịrị ịrụ ọrụ. Treatmentsdị ọgwụgwọ ndị a gụnyere:
- Ndị na-egbochi androgen receptor (nke a na-akpọkwa androgen receptor antagonists), nke bụ ọgwụ ndị na-asọ mpi na androgens maka ijikọ na androgen receptor. Site na asọmpi maka ijikọ ihe na androgen receptor, ọgwụgwọ ndị a na-ebelata ikike nke androgens iji kwalite uto cell cancer.
Ebe ọ bụ na ndị na-egbochi etrogen anaghị egbochi etrogen, ọ naghị adịkarị eji aka ha agwọ ọrịa prostate. Kama nke ahụ, a na-eji ha yana ADT (ma ọ bụ orchiectomy ma ọ bụ LHRH agonist). A na-akpọ ojiji nke androgen receptor blocker yana yana orchiectomy ma ọ bụ LHRH agonist jikọtara androgen, mgbochi zuru ezu androgen, ma ọ bụ ngọngọ androgen.
Androgen receptor blockers nke akwadoro na United States ịgwọ ọrịa cancer prostate gụnyere flutamide, enzalutamide, apalutamide, bicalutamide, na nilutamide. Enyere ha dika ogwu ka ha loda.
Ọgwụ ndị na-egbochi mmepụta nke androgens n'akụkụ ahụ niile gụnyere:
- Androgen synthesis inhibitors, nke bụ ọgwụ na-egbochi mmepụta nke androgens site na adrenal gland na sel cancer prostate n'onwe ha, yana nke testicles. Ma usoro ọgwụgwọ ma ọ bụ nke ịwa ahụ adịghị egbochi gland adrenal na sel cancer prostate ịmịpụta androgens. Ọ bụ ezie na ọtụtụ androgen nke mkpụrụ ndụ ndị a na-emepụta pere mpe, ha nwere ike zuru oke iji kwado uto nke ụfọdụ ọrịa cancer prostate.
Ndị na-eme ihe na-emepụta etrogen nwere ike wedata ogo testosterone n’ahụ mmadụ karịa ka ọgwụgwọ ọ bụla ọzọ mara. Ọgwụ ndị a na-egbochi mmepụta testosterone site na igbochi enzyme a na-akpọ CYP17. Enzyme a, nke dị na testicular, adrenal, na prostor tumor tissues, dị mkpa maka ahụ iji mepụta testosterone site na cholesterol.
A kwadoro ndị na-emechi etrogen atọ na United States: abiraterone acetate, ketoconazole, na aminoglutethimide. A na-enye ha niile dị ka ọgwụ ka ha elo.
A kwadoro acetate Abiraterone na prednisone iji na-agwọ ọrịa cancer na-arịa ọrịa prostate na-emetụta metastatic dị elu. Tupu nnwapụta nke abiraterone na enzalutamide, a na-ejikarị ọgwụ abụọ emepụtara maka ihe ngosi ndị ọzọ karịa ọrịa kansa-ketoconazole na aminoglutethimide-dị ka ọgwụgwọ nke abụọ maka ọrịa cancer prostate na-eguzogide ọgwụ.
Kedu ka esi eji ọgwụgwọ hormone agwọ ọrịa kansa prostate?
Enwere ike iji ọgwụgwọ hormone n'ọtụtụ ụzọ iji gwọọ ọrịa kansa prostate, gụnyere:
Oge mbu nke oria prostate nwere ma obu oke nsogbu nke inweghachi. Menmụ nwoke ndị nwere ọria prostate izizi nke nwere etiti ma ọ bụ nnukwu ihe egwu ịlaghachi azụ na-enwetakarị ọgwụgwọ hormone tupu, n'oge, na / ma ọ bụ mgbe ọgwụgwọ radieshon gasịrị, ma ọ bụ na ha nwere ike ịnata ọgwụgwọ hormone mgbe prostatectomy (ịwa ahụ iji wepụ gland prostate) (6) . Ihe ndị eji eme ihe iji chọpụta ihe egwu nke ọrịa prostate nlọghachị gụnyere ọkwa tumo (dịka a tụrụ ya site na akara Gleason), ókè etuto ahụ gbasasịrị na anụ ahụ gbara ya gburugburu, yana ma a na-ahụ mkpụrụ ndụ akpụ na lymph nọ nso n'oge ịwa ahụ.
Ogologo ọgwụgwọ na ọgwụgwọ hormone maka ọrịa cancer mbụ na-adabere n'ihe ize ndụ nke nwoke ịmalite. Maka ụmụ nwoke nwere ọrịa prostate dị n'etiti, a na-enyekarị ọgwụgwọ hormone maka ọnwa 6; maka ụmụ nwoke nwere nnukwu ọrịa ọ na-enyekarị ọnwa 18-24.
Menmụ nwoke ndị nwere ọgwụgwọ hormone mgbe prostatectomy dị ogologo karịa na-enweghị nlọghachi ọzọ karịa ndị nwere prostatectomy naanị, mana ha anaghị adị ogologo ndụ n'ogologo (6). Menmụ nwoke ndị nwere ọgwụgwọ hormone mgbe usoro ọgwụgwọ radieshọn dịpụrụ adịpụ maka etiti - ma ọ bụ nnukwu ihe ize ndụ nke ọrịa prostate na-adị ogologo ndụ, ma n'ozuzu ma na-enweghị nlọghachi ọzọ, karịa ụmụ nwoke ndị a na-agwọ naanị radieshọn (6, 7). Menmụ nwoke ndị na-anata ọgwụgwọ hormone tinyere ọgwụgwọ radieshon na-adị ogologo ndụ karịa ụmụ nwoke na-anata ọgwụgwọ radieshon naanị (8). Otú ọ dị, oge na oge ADT kachasị mma, tupu na mgbe ọgwụgwọ radieshon, amalitebeghị (9, 10).
Ojiji nke ọgwụgwọ hormone (naanị ya ma ọ bụ na ọgwụ chemotherapy) tupu prostatectomy egosipụtaghị ogologo ndụ ma ọ bụghị usoro ọgwụgwọ. A na-amatakwu ihe mgbochi orrogen kpụ ọkụ n'ọnụ tupu prostatectomy na-anwale ọnwụnwa.
Ọrịa prostate laghachiri / nlọghachi. Usoro ọgwụgwọ Hormone ejiri naanị ya bụ usoro ọgwụgwọ maka ụmụ nwoke nwere ọrịa cancer prostate dịka ederede site na CT, MRI, ma ọ bụ nyocha ọkpụkpụ mgbe ọgwụgwọ ọgwụgwọ radieshon ma ọ bụ prostatectomy. A na-atụ aro usoro ọgwụgwọ oge ụfọdụ maka ụmụ nwoke ndị nwere "biochemical" nlọghachi-ịrị elu na antigen-kpọmkwem antigen (PSA) larịị isi ọgwụgwọ mpaghara na ịwa ahụ ma ọ bụ radieshon-ọkachasị ma ọ bụrụ na ọkwa PSA dị okpukpu abụọ na-erughị ọnwa 3 na ọrịa kansa adịghị kesaa.
Usoro ikpe ụlọ ọgwụ na-enweghị usoro n'etiti ụmụ nwoke ndị nwere ihe ndị na-akpata biochemical mgbe prostatectomy chọpụtara na ụmụ nwoke ndị nwere ọgwụgwọ antiandrogen tinyere ọgwụgwọ radieshon nwere ike ọ gaghị enwe ike ịmalite metastases ma ọ bụ nwụọ site na ọrịa kansa prostate ma ọ bụ n'ozuzu karịa ndị nwere placebo tinyere radieshon (11). Otú ọ dị, ndị ọrịa nwere ụkpụrụ PSA dị ala apụtaghị na ha ritere uru na mgbakwunye nke ọgwụgwọ hormone na radieshon. Ọnwụnwa ahụike ọzọ mere n'oge na-adịbeghị anya gosiri na maka ụmụ nwoke ndị nwere ọkwa PSA na-arị elu mgbe ha gwọchara ọgwụ ndị dị na mpaghara bụ ndị nọ n'ihe ize ndụ nke metastasis mana enweghị ihe akaebe nke ọrịa metastatic, na-agbakwunye chemotherapy na docetaxel na ADT adịghị elu ADT n'ihe gbasara ọtụtụ usoro iji lanarị ( 12).
Ọrịa cancer ma ọ bụ metastatic cancer. Usoro ọgwụgwọ Hormone ejiri naanị ya bụ usoro ọgwụgwọ maka ụmụ nwoke achọpụtara nwere ọrịa metastatic (yabụ, ọrịa agbasawo n'akụkụ ndị ọzọ) mgbe achọpụtara ọrịa cancer prostate ha (13). Ọnwụnwa ahụike egosiwo na ndị dị otú ahụ na-adị ndụ ogologo oge mgbe ha na ADT gbakwunyere abiraterone / prednisone, enzalutamide, ma ọ bụ apalutamide karịa ka a na-emeso ya na ADT naanị (14-17). Otú ọ dị, ebe ọ bụ na ọgwụgwọ hormone nwere ike inwe mmetụta dị ukwuu, ụfọdụ ụmụ nwoke na-ahọrọ ịghara ịgwọ ọgwụgwọ hormone ruo mgbe mgbaàmà malitere.
Nsonaazụ mbụ nke nnwale nke NCI nyere nkwado nke otu abụọ na-akwado ọrịa kansa-ndị Eastern Cooperative Oncology Group (ECOG) na American College of Radiology Imaging Network (ACRIN) — tụrụ aro na ụmụ nwoke ndị nwere ọrịa kansa na-arịa ọrịa prostate metastatic na-anata chemotherapy ọgwụ docetaxel na mmalite nke usoro ọgwụgwọ ọgwụ na-adị ogologo ndụ karịa ụmụ nwoke na-anata ọgwụgwọ naanị ha. Menmụ nwoke nwere ọrịa metastatic kachasị gbasaa pụtara irite uru na mbido mgbakwunye docetaxel. Nchọpụta ndị a gosipụtara na nso nso a site na ịgbaso ogologo oge (18).
Palliation nke mgbaàmà. A na-eji ọgwụgwọ hormone naanị mgbe ụfọdụ maka ịgwọ ọrịa ma ọ bụ mgbochi nke mgbaàmà mpaghara na ụmụ nwoke nwere ọrịa cancer prostate a na-abụghị ndị na-aga ịwa ahụ ma ọ bụ ọgwụgwọ radieshon (19). Ndị dị otú ahụ na-agụnye ndị nwere obere ndụ ndụ, ndị nwere etuto ime obodo, na / ma ọ bụ ndị nwere ajọ ọnọdụ ahụike ọzọ.
Kwado ikwu okwu akpaaka-ume ọhụrụ