Mhando / prostate / prostate-hormone-therapy-chokwadi-sheet
Zviri Mukati
Hormone Therapy yeProstate Kenza
Ndeapi mahormone echirume?
Mahormone zvinhu zvinogadzirwa nema gland mumuviri zvinoshanda semasaini emakemikari. Dzinokanganisa zviito zvemasero nematukisi munzvimbo dzakasiyana mumuviri, kazhinji zvichisvika pazvinangwa zvavo nekufamba neropa.
Androgens (murume pabonde mahormone) iri kirasi yemahormone ayo anodzora kukura uye kugadzirisa kwehunhu hunhu. Testosterone uye dihydrotestosterone (DHT) ndiyo yakawanda androgens muvarume. Anenge ese testosterone anogadzirwa mumachende; shoma shoma inogadzirwa neadrenal glands. Uye zvakare, mamwe maseru emukenza yeprostate anowana kugona kugadzira testosterone kubva kune cholesterol (1).
Hormone inokurudzira sei kukura kwekenza yeprostate?
Androgens anodikanwa kuti akure mukukura uye mashandiro eprostate, gland mune yehurume yekubereka system iyo inobatsira kugadzira urume. Androgens zvakare anodikanwa kuti kenza yeprostate ikure. Androgens inokurudzira kukura kwezvose zvakajairika uye zvine cancer maseru eprostate nekusunga uye nekuita iyo androgen receptor, puroteni inoratidzwa mumasero eprostate (2). Pane imwe nguva yakashandurwa, iyo androgen receptor inokurudzira kutaura kwemajeni chaiwo anokonzera masero eprostate kukura (3).
Pakutanga mukukura kwavo, kenza yeprostate inoda mwero wakakwira wee androgens kuti ikure. Kenza yeprostate yakadaro inonzi castration sensitive, androgen inomira, kana uyerogen tenzi nekuti kurapwa kunodzora uyerogenji mazinga kana kuvharidzira uyerogen chiitiko kunogona kutadzisa kukura kwavo.
Kenza yeprostate inorapwa nemishonga kana kuvhiyiwa iyo inovhara uyerogens pakupedzisira inova inokonzeresa (kana castrate) inodzivirira, zvinoreva kuti vanogona kuramba vachikura kunyangwe kana uyerogen mumuviri wakadzika zvakanyanya kana kusingaonekwe. Munguva yakapfuura aya mamota aishevedzwawo kuti kemikari inodzivirira, uyerogen yakazvimirira, kana hormone inodzora; zvisinei, aya mazwi haawanzo shandiswa ikozvino nekuti mamota ayo ave kusagadzikana kwekututira anogona kupindura kune imwe kana yakawanda yemishonga mitsva yeantiandrogen.
Ndeapi marudzi ehomoni kurapwa anoshandiswa kune kenza yeprostate?
Hormone kurapwa kwekenza yeprostate inogona kutadzisa kugadzirwa kana kushandiswa kwe androgens (4). Parizvino mishonga iripo inogona kuzviita nenzira dzinoverengeka:
- Kuderedza uyerogen kugadzirwa nemachende
- Kuvhara chiito che androgens mumuviri wese
- Bvisa uyerogen kugadzirwa (synthesis) mumuviri wese
Marapirwo anoderedza uyerogen kugadzirwa nemachende ndiwo anonyanya kushandiswa mahormone ekurapa kenza yeprostate uye yekutanga mhando yekurapa kwehomoni iyo varume vazhinji vane gomarara reprostate vanogashira. Iyi fomu yehomoni yekurapa (inonziwo uyerogen kunyima kurapa, kana ADT) inosanganisira:
- Orchiectomy, chirongwa chekuvhiya kubvisa rimwe kana maviri machende. Kubviswa kwemachende kunogona kudzikisa mwero we testosterone muropa ne 90 kusvika 95% (5). Rudzi urwu rwekurapa, rwunonzi rwekuvhiya kukanda, runogara nekusingaperi. Rudzi rwe orchiectomy runonzi subcapsular orchiectomy rinobvisa chete munyama mumachende unoburitsa uyerogen, panzvimbo penzvimbo yese.
- Zvinodhaka zvinonzi luteinizing hormone-releasing hormone (LHRH) agonists, izvo zvinodzivirira kubviswa kwehormone inonzi luteinizing hormone. LHRH agonists, ayo dzimwe nguva anonzi LHRH analogs, anogadzira mapuroteni akaumbwa zvakafanana neLHRH uye anosunga kune iyo LHRH receptor mune yepituitary gland. (LHRH inozivikanwa zvakare segonadotropin-inosunungura mahormone kana GnRH, saka maLHRH agonists anonziwo GnRH agonists.)
Kazhinji, kana uyerogen mumuviri wakaderera, LHRH inokurudzira iyo pituitary gland kuti ibudise luteinizing hormone, iyo inomutsiridza machende kuti abudise uyerogen. LHRH agonists, senge iyo yemuviri LHRH, pakutanga inokurudzira kugadzirwa kwe luteinizing hormone. Nekudaro, kuenderera mberi kwekuvapo kwenzvimbo dzakakwira dzeLHRH agonists kunokonzeresa kuti chirwere chepituitary chimire kuburitsa luteinizing hormone, uye semhedzisiro machende haasimudzirwe kuburitsa uyerogen.
Kurapa neagrist yeLHRH kunodaidzwa kunzi kurapa kukanda kana chemakemikari kukanda nekuti inoshandisa zvinodhaka kuita chinhu chimwe chete sekuvhiya (orchiechtomy). Asi, kusiyana neorchiectomy, mhedzisiro yemishonga iyi pakugadzirwa kwe androgen inodzoserwa. Kamwe kurapwa kukamiswa, kugadzirwa kwe androgen kunowanzo tangazve.
LHRH agonist anopihwa jekiseni kana akaisirwa pasi peganda. Vane LHRH agonists vanobvumidzwa kurapa kenza yeprostate muUnited States: leuprolide, goserelin, triptorelin, uye histrelin.
Kana varwere vakagamuchira agonist weLHRH kekutanga, vanogona kusangana nechinhu chinonzi "testosterone flare." Uku kuwedzera kwechinguva padanho re testosterone kunoitika nekuti maLHRH agonist anokonzeresa kuti chirwere chepituitary chibudise mamwe luteinizing mahormone isati yavhara kuburitswa kwayo. Izvo zvinopisa zvinogona kuwedzera zviratidzo zvekiriniki (semuenzaniso, kurwadziwa kwepfupa, ureter kana bladder kuburitsa, uye musana tambo kumanikidza), inova inogona kunge iri dambudziko mune varume vane gomarara reprostate. Kuwedzera kwe testosterone kunowanzo kuverengerwa nekupa imwe mhando yehomoni yekurapa inonzi antiandrogen kurapa pamwe neiyo LHRH agonist kwemavhiki ekutanga ekurapwa.
- Zvinodhaka zvinonzi LHRH vanopikisa, iri imwe nzira yekurapa. Vapikisi veLHRH (vanonziwo vanopokana neGnRH) vanodzivirira LHRH kubva mukusunga kune avo vanogamuchira mupituitary gland. Izvi zvinodzivirira kuchengetedzwa kwe luteinizing hormone, iyo inomisa machende kubva mukugadzira uyerogen. Kusiyana neLHRH agonists, vanopikisa veLHRH havakonzere testosterone flare.
Mumwe anopikisa LHRH, degarelix, parizvino anotenderwa kurapa kenza yeprostate cancer muUnited States. Inopihwa jekiseni.
- Estrogens (mahormone anokurudzira hunhu hwevakadzi pabonde). Kunyangwe estrogens ichikwanisawo kudzora uyerogen kugadzirwa nemachende, haawanzo shandiswa nhasi pakurapa gomarara reprostate nekuda kwemhedzisiro yavo.
Mishonga inorambidza chiito che androgens mumuviri (inonziwo antiandrogen Therapies) inowanzo shandiswa ADT painomira kushanda. Mishonga yakadaro inosanganisira:
- Androgen receptor blockers (inonziwo androgen receptor antagonists), ayo ari madhiragi anokwikwidza ne androgens yekusunga kune iyo androgen receptor. Nekukwikwidza kusunga kune iyo androgen receptor, aya marapirwo anoderedza kugona kwe androgens kusimudzira gomarara reprostate cell kukura.
Nekuti androgen receptor blockers haivharidze uyerogen kugadzirwa, ivo havawanzo shandiswa vega kurapa cancer yekenza. Asi, iwo anoshandiswa pamwe chete neADT (ingave orchiectomy kana iyo LHRH agonist). Kushandiswa kweanorrogen receptor blocker pamwe chete neorchiectomy kana iyo LHRH agonist inonzi yakasanganiswa uyerogen blockade, yakazara uyerogen blockade, kana yakazara uyerogen blockade.
Androgen receptor blockers ayo anotenderwa muUnited States kurapa cancer yeprostate inosanganisira flutamide, enzalutamide, apalutamide, bicalutamide, uye nilutamide. Vanopihwa semapiritsi ekumedzwa.
Mishonga inorambidza kugadzirwa kwe androgens mumuviri wese inosanganisira:
- Androgen synthesis inhibitors, ayo ari madhiragi anodzivirira kugadzirwa kwe androgens neadrenal gland uye maseru emukenza yeprostate ivo pachavo, pamwe nemachende. Kana zvekurapa kana zvekuvhiya castrate inodzivirira iyo adrenal gland uye maseru ekenza yeprostate kubva mukugadzira androgens. Kunyangwe hazvo huwandu hwee androgens aya maseru anoburitsa ari madiki, anogona kuve akakwana kutsigira kukura kweimwe gomarara reprostate.
Androgen synthesis inhibitors inogona kudzikisa testosterone mazinga mumuviri wemurume kusvika padanho rakakura kupfuura chero imwe inozivikanwa kurapwa. Iyi mishonga inovhara testosterone kugadzirwa nekudzivirira enzyme inonzi CYP17. Iyi enzyme, iyo inowanikwa mu testicular, adrenal, uye prostate tumarara nyama, inodikanwa kuti muviri ubudise testosterone kubva kune cholesterol.
Vatatu uyerogen synthesis inhibitors anotenderwa muUnited States: abiraterone acetate, ketoconazole, uye aminoglutethimide. Zvese zvinopihwa semapiritsi ekumedzwa.
Abiraterone acetate inogamuchirwa pamwe ne prednisone kurapa metastatic yakanyanya-njodzi yekukanda-inonzwisisika gomarara reprostate uye metastatic castration-isingagadzirise kenza yeprostate. Pamberi pekubvumidzwa kweabiraterone ne enzalutamide, mishonga miviri yakatenderwa kuratidza kunze kwekenza yeprostate-ketoconazole uye aminoglutethimide-dzimwe nguva yaishandiswa-kurembedzwa semutsara wechipiri kurapa gomarara reprostate risingapindiki.
Kurapa kwehomoni kunoshandiswa sei kurapa kenza yeprostate?
Hormone therapy inogona kushandiswa munzira dzinoverengeka kurapa kenza yeprostate, inosanganisira:
Yekutanga-danho gomarara reprostate ine wepakati kana njodzi huru yekudzokazve. Varume vane gomarara reprostate rekutanga-padanho rine mukana wepakati kana wepamusoro wekudzokororwa vanowanzo gamuchira kurapwa kwehomoni pamberi, panguva, uye / kana mushure mekurapwa nemwaranzi, kana ivo vanogona kupihwa hormone kurapwa mushure meprostatectomy (kuvhiyiwa kubvisa iyo gland yeprostate) (6) . Zviitiko izvo zvinoshandiswa kuona njodzi yekenza yeprostate inodzokororazve inosanganisira gumbo rebundu (sekuyerwa neGleason mamakisi), iro iro bundu rakapararira muzvinyama zvakakomberedza, uye kana maseru emota anowanikwa mune lymph node dzepedyo panguva yekuvhiyiwa.
Kureba kwekurapwa nehomoni yekurapa kwechikamu chepakutanga-gomarara reprostate kunoenderana nenjodzi yemurume yekudzokazve. Kune varume vane chepakati-njodzi-kenza yeprostate, kurapwa kwehomoni kunowanzo kupihwa kwemwedzi mitanhatu; yevarume vane chirwere chine njodzi huru inowanzo kupihwa kwemwedzi gumi nemasere nemakumi maviri nemana.
Varume vane hormone therapy mushure meprostatectomy vanorarama kwenguva refu vasina kudzokororwa pane varume vane prostatectomy voga, asi havagare kwenguva yakareba (6). Varume vane hutachiona hwehomoni mushure mekunze beam radiation kurapwa kweanopindirana- kana ane njodzi-kenza yeprostate vanorarama kwenguva yakareba, zvese zvakazara uye vasina kudzokerazve, kupfuura varume vanorapwa ne radiation radiation chete (6, 7). Varume vanogamuchira kurapa kwehomoni mukubatana neye radiation radiation vanorarama zvakareba kwenguva yakareba kupfuura varume vanogamuchira radiation radiation chete (8). Nekudaro, iyo yakaringana nguva uye nguva yeADT, pamberi uye mushure mekurapwa nemwaranzi, haina kusimbiswa (9, 10).
Iko kushandiswa kwehomoni yekurapa (yega kana musanganiswa nekemotherapy) pamberi peprostatectomy isati yaratidzirwa kuti iwedzere kupona uye haisi kurapwa kwakazara. Zvimwe zvakanyanyisa uyerogen blockade pamberi pe prostatectomy iri kuongororwa mumakiriniki ekuedzwa.
Yakadzokororwa / yakajairika kenza yeprostate Hormone therapy inoshandiswa yoga ndiyo yakajairwa kurapwa kwevarume vane gomarara reprostate rinodzokororwa sezvakanyorwa neCCT, MRI, kana bone scan mushure mekurapwa ne radiation radiation kana prostatectomy. kurapwa dzimwe nguva kunokurudzirwa kune varume vane kudzokororwa kwe "biochemical" - kukwira kweprostate-yakatarwa antigen (PSA) nhanho zvichitevera kurapwa kwekutanga nekuvhiya kana radiation - kunyanya kana iyo PSA yakawedzera zvakapetwa mukati memwedzi isingasviki mitatu uye gomarara risina paradzira.
Kuongororwa kwechirongwa chekiriniki pakati pevarume vane biochemical kudzoka mushure meprostatectomy vakawana kuti varume vaive neantiandrogen kurapa pamwe nekurapwa nemwaranzi vaive nemikana mishoma yekukudziridza metastases kana kufa nekenza yeprostate kana yakazara pane varume vaive ne placebo pamwe nemwaranzi (11). Nekudaro, varwere vane yakaderera PSA tsika havana kuita sevanobatsirwa kubva mukuwedzera kwehomoni kurapwa kune radiation. Imwe yazvino kiriniki kuyedzwa yakaratidza kuti kune varume vane kuwedzera kwePSA mazinga mushure mekutanga kurapwa kweruwa vaive nenjodzi yakakura yemastastasis asi vasina humbowo hwechirwere chemastastatic, vachiwedzera chemotherapy ne docetaxel kuADT yakanga isiri yepamusoro kune ADT maererano nezviyero zvakati kuti zvekupona ( 12).
Yepamberi kana metastatic kenza yeprostate. Hormone therapy inoshandiswa yoga ndiyo yakajairwa kurapwa kwevanhurume vanowanikwa vaine chirwere chemastastatic (kureva, chirwere chakapararira kune mamwe mativi emuviri) apo gomarara ravo reprostate rinotanga kuongororwa (13). Kliniki miedzo yakaratidza kuti varume vakadaro vanorarama kwenguva yakareba kana vachirapwa neADT pamwe neabiraterone / prednisone, enzalutamide, kana apalutamide kupfuura pavanorapwa neADT chete (14-17). Nekudaro, nekuti kurapa kwehomoni kunogona kuva nemhedzisiro, vamwe varume vanosarudza kusatora mushonga wehomoni kudzamara zviratidzo zvatanga.
Early results of an NCI-sponsored trial that was conducted by two cancer cooperative groups—the Eastern Cooperative Oncology Group (ECOG) and the American College of Radiology Imaging Network (ACRIN)—suggested that men with hormone-sensitive metastatic prostate cancer who receive the chemotherapy drug docetaxel at the start of standard hormone therapy live longer than men who receive hormone therapy alone. Men with the most extensive metastatic disease appeared to benefit the most from the early addition of docetaxel. These findings were recently confirmed with longer follow-up (18).
Kufungidzirwa kwezviratidzo. Hormone Therapisi dzimwe nguva inoshandiswa yoga kupora kana kudzivirira kwezviratidzo zvemuno muvarume vane gomarara reprostate vasiri mukwati wekuvhiya kana radiation radiation (19). Varume vakadaro vanosanganisira avo vane tarisiro yehupenyu shoma, avo vane mamota akakwira emuno, uye / kana avo vane mamwe mamiriro ehutano hwakakomba.
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