Mitundu / prostate / prostate-hormone-therapy-fact-sheet
Thandizo la Hormone la Khansa ya Prostate
Kodi mahomoni ogonana amuna ndi akazi ndi ati?
Mahomoni ndi zinthu zopangidwa ndi tiziwalo timene timatulutsa thupi lomwe limagwira ntchito ngati chizindikiro cha mankhwala. Zimakhudza zochita zamaselo ndi zotupa m'malo osiyanasiyana mthupi, nthawi zambiri zimakwaniritsa zolinga zawo poyenda m'magazi.
Androgens (mahomoni ogonana amuna ndi akazi) ndi gulu la mahomoni omwe amayang'anira kukula ndi kukonza mawonekedwe amwamuna. Testosterone ndi dihydrotestosterone (DHT) ndi ma androgens ambiri mwa amuna. Pafupifupi testosterone yonse imapangidwa m'matumbo; pang'ono amapangidwa ndi adrenal glands. Kuphatikiza apo, maselo ena a khansa ya prostate amatha kupanga testosterone kuchokera ku cholesterol (1).
Kodi mahomoni amalimbikitsa bwanji kukula kwa khansa ya prostate?
Androgens amafunika pakukula bwino ndikugwira ntchito kwa prostate, gland m'machitidwe oberekera amuna omwe amathandizira kupanga umuna. Androgens ndiofunikanso kuti khansa ya prostate ikule. Androgens amalimbikitsa kukula kwa maselo abwinobwino komanso khansa ya prostate pomangiriza ndi kuyambitsa androgen receptor, puloteni yomwe imafotokozedwa m'maselo a Prostate (2). Akalandira, cholandilira cha androgen chimalimbikitsa kufotokoza kwa majini ena omwe amachititsa kuti ma prostate akule (3).
Kumayambiriro kwa kukula kwawo, khansa ya prostate imafunikira milingo yambiri ya androgens kuti ikule. Khansa yotere ya prostate imatchedwa kuti castration sensitive, androgen yodalira, kapena androgen tcheru chifukwa mankhwala omwe amachepetsa milingo ya androgen kapena kuletsa ntchito ya androgen atha kuletsa kukula kwawo.
Khansa ya Prostate yothandizidwa ndi mankhwala kapena opareshoni yomwe imaletsa ma androgens kumapeto kwake imakhala yotupa (kapena yotupa), zomwe zikutanthauza kuti zimatha kupitilirabe kukula ngakhale milingo ya androgen m'thupi imakhala yotsika kwambiri kapena yosawoneka. M'mbuyomu zotupazi zimadziwikanso kuti zoteteza ku mahomoni, zoteteza ku androgen, kapena zotulutsa mahomoni; komabe, mawuwa sagwiritsidwa ntchito kawirikawiri pano chifukwa zotupa zomwe zakhala zosagwedezeka kwambiri zimatha kuyankha mankhwala amodzi kapena angapo atsopano a antiandrogen.
Kodi ndimankhwala amtundu wanji omwe amagwiritsidwa ntchito pa khansa ya prostate?
Mankhwala a mahomoni a khansa ya prostate amatha kuletsa kupanga kapena kugwiritsa ntchito ma androgens (4). Mankhwala omwe alipo pakadali pano atha kuchita izi m'njira zingapo:
- Kuchepetsa kupanga kwa androgen ndi machende
- Kuletsa machitidwe a androgens mthupi lonse
- Letsani kupanga kwa androgen (kaphatikizidwe) mthupi lonse
Mankhwala omwe amachepetsa kutulutsa kwa androgen ndi machende ndi mankhwala omwe amagwiritsidwa ntchito kwambiri ndi khansa ya prostate komanso mtundu woyamba wamankhwala omwe amuna ambiri omwe ali ndi khansa ya prostate amalandira. Mtundu uwu wamankhwala amtundu wa mahomoni (womwe umatchedwanso kuti androgen kunyamula mankhwala, kapena ADT) umaphatikizapo:
- Orchiectomy, njira yochotsera machende amodzi kapena onse awiri. Kuchotsa machende kumatha kuchepetsa kuchuluka kwa testosterone m'magazi ndi 90 mpaka 95% (5). Chithandizo chamtunduwu, chotchedwa kutaya opareshoni, ndichokhazikika komanso chosasinthika. Mtundu wa orchiectomy wotchedwa subcapsular orchiectomy umachotsa minofu m'matumba okha yomwe imatulutsa ma androgens, osati thumba lonse.
- Mankhwala otchedwa luteinizing hormone-releasing hormone (LHRH) agonists, omwe amaletsa kutulutsa kwa hormone yotchedwa luteinizing hormone. Agonists a LHRH, omwe nthawi zina amatchedwa ma LHRH, ndi mapuloteni opanga omwe amafanana ndi LHRH ndipo amamangiriza kulandila la LHRH mumatumbo a pituitary. (LHRH imadziwikanso kuti gonadotropin-releasing hormone kapena GnRH, chifukwa chake ma LHRH agonists amatchedwanso GnRH agonists.)
Nthawi zambiri, kuchuluka kwa androgen m'thupi kumakhala kotsika, LHRH imathandizira gland ya pituitary kupanga mahomoni a luteinizing, omwe amapangitsa kuti machende apange ma androgens. Agonist a LHRH, monga thupi la LHRH, poyamba amalimbikitsa kupanga mahomoni a luteinizing. Komabe, kupezeka kwaposachedwa kwa agonists a LHRH kumapangitsa kuti pituitary gland ileke kutulutsa mahomoni a luteinizing, ndipo chifukwa chake machende samalimbikitsidwa kuti apange ma androgens.
Chithandizo cha agonist wa LHRH chimatchedwa kuchotsedwa kwa mankhwala kapena kuponyera mankhwala chifukwa chimagwiritsa ntchito mankhwala osokoneza bongo kuti achite zomwezo monga opaleshoni yotulutsa (orchiechtomy). Koma, mosiyana ndi orchiectomy, zotsatira za mankhwalawa pakupanga kwa androgen zimasinthidwa. Mankhwala akayimitsidwa, kupanga androgen nthawi zambiri kumayambiranso.
Agonist a LHRH amapatsidwa jakisoni kapena amaikidwa pansi pa khungu. Agonists anayi a LHRH avomerezedwa kuti athetse khansa ya prostate ku United States: leuprolide, goserelin, triptorelin, ndi histrelin.
Odwala akamalandira agonist a LHRH koyamba, atha kukhala ndi vuto lotchedwa "testosterone flare." Kuwonjezeka kwakanthawi pamlingo wa testosterone kumachitika chifukwa agonists a LHRH mwachidule amachititsa kuti pituitary gland itulutse mahomoni owonjezera asanatseke kutulutsidwa kwake. Kuwotcha kumatha kukulitsa zizindikiritso zamatenda (mwachitsanzo, kupweteka kwa mafupa, kutsekeka kwa ureter kapena chikhodzodzo, ndi kupsinjika kwa msana), zomwe zingakhale vuto makamaka kwa amuna omwe ali ndi khansa ya prostate. Kuwonjezeka kwa testosterone nthawi zambiri kumayesedwa ndikupereka mtundu wina wamankhwala otchedwa antiandrogen therapy limodzi ndi agonist wa LHRH m'masabata angapo oyamba achipatala.
- Mankhwala osokoneza bongo omwe amatchedwa antagonists a LHRH, omwe ndi njira ina yothandizira odwala. Otsutsa a LHRH (omwe amatchedwanso kuti GnRH antagonists) amaletsa LHRH kuti isamamangirire kumalo ake am'mimba. Izi zimalepheretsa kutulutsa mahomoni a luteinizing, omwe amaletsa machende kuti asatulutse ma androgens. Mosiyana ndi agonists a LHRH, omwe amatsutsana ndi LHRH samayambitsa testosterone.
Wotsutsana ndi LHRH, degarelix, akuvomerezedwa kuti athetse khansa ya prostate ku United States. Amaperekedwa ndi jakisoni.
- Estrogens (mahomoni omwe amalimbikitsa machitidwe azimayi ogonana). Ngakhale ma estrogens amathanso kuletsa kupanga kwa androgen ndi machende, sagwiritsidwa ntchito masiku ano pochiza khansa ya prostate chifukwa cha zoyipa zake.
Mankhwala omwe amaletsa zochita za androgens m'thupi (amatchedwanso antiandrogen Therapies) amagwiritsidwa ntchito ADT ikasiya kugwira ntchito. Mankhwalawa ndi awa:
- Androgen receptor blockers (omwe amatchedwanso a androgen receptor antagonists), omwe ndi mankhwala omwe amapikisana ndi ma androgens omangiriza kulandirira a androgen. Mwa kupikisana kuti muzimanga nawo receptor ya androgen, mankhwalawa amachepetsa kuthekera kwa ma androgens olimbikitsa kukula kwa khungu la prostate.
Chifukwa ma androgen receptor blockers samaletsa kupanga kwa androgen, samagwiritsidwa ntchito kawirikawiri kuti athetse khansa ya prostate. M'malo mwake, amagwiritsidwa ntchito limodzi ndi ADT (mwina orchiectomy kapena agonist wa LHRH). Kugwiritsa ntchito cholandilira cha androgen kuphatikiza ndi orchiectomy kapena agonist wa LHRH amatchedwa blockrogen blockade, block block ya androgen, kapena block block ya androgen.
Androgen receptor blockers omwe amavomerezedwa ku United States kuti athetse khansa ya prostate ndi flutamide, enzalutamide, apalutamide, bicalutamide, ndi nilutamide. Amapatsidwa ngati mapiritsi oti amezeke.
Mankhwala omwe amaletsa kupanga ma androgens mthupi lonse ndi awa:
- Androgen synthesis inhibitors, omwe ndi mankhwala omwe amaletsa kupanga ma androgens ndimatenda a adrenal komanso ma cell a khansa ya prostate iwowo, komanso machende. Kutaya kapena kuchotsa opaleshoni sikuletsa ma adrenal gland ndi maselo a khansa ya prostate kuti asatulutse ma androgens. Ngakhale kuchuluka kwa ma androgens omwe maselowa amapanga ndi ochepa, amatha kukhala okwanira kuthandizira kukula kwa khansa ya prostate.
Androgen synthesis inhibitors amatha kutsitsa ma testosterone mthupi la munthu kwambiri kuposa mankhwala ena aliwonse odziwika. Mankhwalawa amaletsa kupanga testosterone poletsa enzyme yotchedwa CYP17. Enzyme imeneyi, yomwe imapezeka m'matumbo a testicular, adrenal, ndi prostate tumor, ndiyofunikira kuti thupi lipange testosterone kuchokera ku cholesterol.
Mitundu itatu ya androgen synthesis inhibitors imavomerezedwa ku United States: abiraterone acetate, ketoconazole, ndi aminoglutethimide. Onse amaperekedwa ngati mapiritsi oti amezeke.
Abiraterone acetate imavomerezedwa kuphatikiza ndi prednisone pochiza khansa ya prostate yomwe imawopsa kwambiri komanso khansa ya prostate yosagwedezeka. Asanapatsidwe chilolezo cha abiraterone ndi enzalutamide, mankhwala awiri omwe amavomerezedwa kuti asonyeze kupatula khansa ya prostate-ketoconazole ndi aminoglutethimide-nthawi zina amagwiritsidwa ntchito ngati mankhwala achiwiri a khansa ya prostate yosagwira.
Kodi mankhwala a mahomoni amagwiritsidwa ntchito bwanji pochiza khansa ya prostate?
Mankhwala a Hormone atha kugwiritsidwa ntchito m'njira zingapo zochizira khansa ya prostate, kuphatikiza:
Khansara ya prostate yoyambirira yomwe ili pachiwopsezo chapakati kapena chowopsa chobwereranso. Amuna omwe ali ndi khansa ya prostate yoyambirira yomwe imakhala yapakati kapena pachiwopsezo chachikulu chobwereranso nthawi zambiri amalandila chithandizo cham'madzi isanafike, nthawi, kapena / kapena mankhwala a radiation, kapena atha kulandira mankhwala a mahomoni pambuyo pa prostatectomy (opaleshoni yochotsa prostate gland) (6) . Zinthu zomwe zimagwiritsidwa ntchito kuti zidziwitse kuopsa kwa khansa ya prostate zimaphatikizaponso kuchuluka kwa chotupacho (monga momwe amayeza ndi Gleason score), momwe chotupacho chafalikira m'matupi oyandikana nawo, komanso ngati ma cell am'mimba amapezeka m'matumba oyandikana nawo nthawi yochita opaleshoni.
Kutalika kwa chithandizo ndi mankhwala a mahomoni a khansa ya Prostate koyambirira kumadalira chiopsezo chamunthu chobwereranso. Kwa amuna omwe ali ndi khansa yapakati yomwe ili pachiwopsezo, mankhwala a mahomoni amaperekedwa kwa miyezi 6; kwa amuna omwe ali ndi matenda oopsa nthawi zambiri amaperekedwa kwa miyezi 18-24.
Amuna omwe ali ndi chithandizo cha mahomoni atatha prostatectomy amakhala ndi moyo wautali osabwereranso kuposa amuna omwe ali ndi prostatectomy okha, koma samakhala motalikirapo (6). Amuna omwe amalandira mankhwala a mahomoni atachotsedwa kunja kwa mankhwala a radiation a khansa yapakati kapena yoopsa kwambiri amakhala ndi moyo wautali, onse komanso osabwerezanso, kuposa amuna omwe amathandizidwa ndi radiation radiation okha (6, 7). Amuna omwe amalandira mankhwala a mahomoni kuphatikiza ndi mankhwala a radiation amakhalanso ndi moyo wautali kuposa amuna omwe amalandira chithandizo cha radiation okha (8). Komabe, nthawi komanso kutalika kwa ADT, isanachitike komanso itatha mankhwala a radiation, sinakhazikitsidwe (9, 10).
Kugwiritsa ntchito mankhwala a mahomoni (okha kapena kuphatikiza ndi chemotherapy) pamaso pa prostatectomy sikunawonetsedwe kuti kutalikitsa moyo ndipo si mankhwala wamba. Kulimbitsa kwakukulu kwa androgen asanachitike prostatectomy kumaphunziridwa m'mayesero azachipatala.
Khansa ya prostate yobwereranso / yobwereza. Chithandizo cha mahomoni chomwe chimagwiritsidwa ntchito chokha ndichithandizo chovomerezeka kwa amuna omwe amabwereranso ndi khansa ya prostate monga zafotokozedwera ndi CT, MRI, kapena scan scan atachiritsidwa ndi radiation radiation kapena prostatectomy. Mankhwalawa amalimbikitsidwa nthawi zina kwa amuna omwe ali ndi "biochemical" mobwerezabwereza-kukwera kwa prostate-specific antigen (PSA) msinkhu wotsatira chithandizo choyambirira chapafupi ndi opaleshoni kapena ma radiation-makamaka ngati msinkhu wa PSA umachulukirachepera miyezi yochepera 3 ndipo khansara kufalitsa.
Kuyesedwa kwamankhwala mwachisawawa pakati pa amuna omwe amabwerezabwereza zamankhwala atatha prostatectomy adapeza kuti amuna omwe anali ndi mankhwala a antiandrogen kuphatikiza mankhwala a radiation anali ocheperako pamatenda kapena kufa ndi khansa ya prostate kapena onse kuposa amuna omwe anali ndi placebo kuphatikiza radiation [11]. Komabe, odwala omwe ali ndi mfundo zochepa za PSA sawoneka kuti akupindula ndi kuwonjezera kwa mankhwala a mahomoni ku radiation. Chiyeso china chaposachedwa chikuwonetsa kuti kwa amuna omwe ali ndi kuchuluka kwa PSA atalandira chithandizo chamankhwala choyambirira omwe anali pachiwopsezo chachikulu cha metastasis koma alibe umboni wa matenda am'mimba, kuwonjezera chemotherapy ndi docetaxel ku ADT sikunapose ADT potengera njira zingapo zopulumukira ( 12).
Khansara yotsogola kapena metastatic prostate. Mankhwala a mahormone omwe amagwiritsidwa ntchito pawokha ndi omwe amathandizira amuna omwe amapezeka kuti ali ndi matenda am'mimba (mwachitsanzo, matenda omwe afalikira mbali zina za thupi) khansa ya prostate ikapezeka koyamba (13). Mayesero azachipatala awonetsa kuti amuna otere amakhala ndi moyo nthawi yayitali akamalandira ADT kuphatikiza abiraterone / prednisone, enzalutamide, kapena apalutamide kuposa momwe amathandizidwira ndi ADT okha (14-17). Komabe, chifukwa mankhwala a mahomoni amatha kukhala ndi zovuta zina, amuna ena samakonda kumwa mankhwala a mahomoni mpaka zizindikiritso zitayamba.
Zotsatira zoyambirira zamilandu yothandizidwa ndi NCI yomwe idachitika ndi magulu awiri a khansa - Eastern Cooperative Oncology Group (ECOG) ndi American College of Radiology Imaging Network (ACRIN) - akuti amuna omwe ali ndi khansa ya prostate ya metastatic yomwe imalandira chemotherapy drug docetaxel koyambirira kwamankhwala amtundu wa mahomoni amakhala nthawi yayitali kuposa amuna omwe amalandila okha mankhwala a mahomoni. Amuna omwe ali ndi matenda ofala kwambiri amtunduwu amawoneka opindulitsa kwambiri pakuwonjezera koyambirira kwa docetaxel. Zotsatira izi zatsimikiziridwa posachedwa ndikutsatira kwakanthawi [18].
Kuthana ndi zizindikiro. Thandizo la mahomoni nthawi zina limagwiritsidwa ntchito lokha pofuna kuchepetsa kapena kupewa zizindikiritso zam'deralo mwa amuna omwe ali ndi khansa ya prostate yomwe siyiyenera kuchitidwa opaleshoni kapena mankhwala a radiation (19). Amuna oterewa ndi omwe amakhala ndi zaka zochepa, omwe ali ndi zotupa zakomweko, ndi / kapena ena omwe ali ndi zovuta zina zathanzi.
Thandizani kutsitsimutsa kwama ndemanga