Noocyada / qanjirka 'prostate-hormone-therapy-fact-sheet
Daaweynta Hormone ee Kansarka Prostate
Waa maxay hormoonnada galmada labku?
Hormoonnada waa walxo ay sameeyaan qanjidhada jirka oo u shaqeeya calaamadaha kiimikada. Waxay saameyn ku yeeshaan ficilada unugyada iyo unugyada meelo kala duwan oo jirka ah, iyagoo inta badan gaara bartilmaameedyadooda iyagoo ku dhex maraya marinnada dhiigga.
Androgens (hormoonnada galmada ee labka ah) waa nooc ka mid ah hormoonnada xukuma horumarinta iyo dayactirka astaamaha ragga. Hormoonkaas iyo dihydrotestosterone (DHT) waa kuwa ugu badan ee androgens ee ragga ku jira. Ku dhowaad dhammaan testosterone waxaa lagu soo saaray xiniinyaha; qadar yar ayaa soo saara qanjidhada adrenal. Intaa waxaa dheer, qaar ka mid ah unugyada kansarka qanjirka 'prostate' waxay helaan awood ay testosterone uga sameystaan kolestaroolka (1).
Sidee hormoonnadu u kiciyaan koritaanka kansarka qanjirka 'prostate'?
Androgens ayaa looga baahan yahay koritaanka caadiga ah iyo shaqada qanjirka 'prostate', oo ah qanjir ku jira nidaamka taranka ragga oo ka caawiya samaynta shahwada. Androgens sidoo kale waa lagama maarmaan kansarka qanjirka 'prostate' inuu kobo. Androgens waxay kor u qaadaan koritaanka labada unug ee qanjidhka caadiga ah iyo kansarka iyagoo ku xidha kuna kiciya soo-dhoweynta androgen, borotiin lagu muujiyey unugyada qanjirka 'prostate' (2). Marka la hawlgeliyo, qalliinka androgen wuxuu kiciyaa muujinta hiddo-wadaha qaaska ah ee sababa unugyada qanjirka 'prostate' inay koraan (3).
Horraanti horumarkooda, kansarrada qanjirka 'prostate' waxay u baahan yihiin heerar aad u sarreeya oo androgens si ay u koraan. Kansarka qanjirka 'prostate' noocan oo kale ah waxaa loo yaqaan 'castration sensitive, androgen dependant, ama androgen sensitive maxaa yeelay daaweynta yareysa heerarka androgen ama xannibaadda firfircoonida iyo jirka ayaa hor istaagi karta koritaankooda.
Kansarka qanjirka 'prostate' ee lagu daweeyo daroogada ama qalliinka xannibaadda androgens-ka ayaa ugu dambeyntii noqda castration (ama castrate) adkaysi u leh, taas oo macnaheedu yahay inay sii wadi karaan inay koraan xitaa marka heerarka androgen ee jirka ay aad u hooseeyaan ama aan la ogaan karin. Waagii hore burooyinkan waxaa sidoo kale loo yaqaan hormoon u adkaysta, androgen madaxbanaan, ama diidmo hormoon; si kastaba ha noqotee, ereyadan si dhif ah ayaa loo isticmaalaa hadda maxaa yeelay burooyinka noqdey kuwa u adkaysta castration waxay ka jawaabi karaan mid ama in ka badan oo ka mid ah daawooyinka cusub ee antiandrogen.
Noocee ah daaweynta hoormoonka loo isticmaalo kansarka qanjirka 'prostate'?
Daaweynta hormoonka ee kansarka qanjirka 'prostate' wuxuu xannibayaa soosaarka ama isticmaalka androgens (4). Daaweynta hadda la heli karo waxay ku samayn kartaa dhowr siyaabood:
- Yaraynta wax soo saarka androgen ee xiniinyaha
- Joojinta ficil-celinta asrogens jirka oo dhan
- Jooji wax soo saarka androgen (synthesis) jirka oo dhan
Daawooyinka yareeya wax soo saarka androgen ee xiniinyaha ayaa ah kuwa ugu badan ee loo isticmaalo daaweynta daaweynta hoormoonka kansarka qanjirka 'prostate' iyo nooca ugu horreeya ee daaweynta hoormoonka ee ragga intooda ugu badan ee qaba kansarka qanjirka 'prostate' ay helaan. Noocan ah daaweynta hoormoonka (oo sidoo kale loo yaqaanno daaweynta ka-haynta androgen, ama ADT) waxaa ku jira:
- Orchiectomy, oo ah hanaan qalliin oo looga soo saaro mid ama labada xiniinyood. Ka saarida xiniinyaha waxay yareyn kartaa heerka testosterone ee dhiiga 90 ilaa 95% (5). Daaweynta noocan ah, oo loo yaqaan 'castration castration', waa mid joogto ah oo aan laga soo kabsan karin. Nooc ka mid ah orchiectomy oo la yiraahdo subcapsular orchiectomy ayaa soo saaraya kaliya unugyada ku jira xiniinyaha ee soo saara androgens, halkii laga saari lahaa xiniinyaha oo dhan.
- Daawooyinka loo yaqaan 'luteinizing hormone-release hormone (LHRH) agonists, oo ka hortaga dheecaanka hoormoonka loo yaqaan' luteinizing hormone '. Cudurka 'LHRH agonists', oo mararka qaarkood loo yaqaan 'LHRH analogs', waa borotiinno isku dhafan oo qaab dhismeed ahaan la mid ah LHRH isla markaana ku xidhan qanjiraha LHRH ee qanjirka 'pituitary gland' (LHRH waxaa sidoo kale loo yaqaanaa hoormoonka sii deynta gonadotropin ama GnRH, marka LHRH agonists waxaa sidoo kale loo yaqaan 'GnRH agonists.)
Caadi ahaan, marka heerarka androgen ee jirka ay hooseeyaan, LHRH waxay kicisaa qanjirka 'pituitary gland' si uu u soo saaro hormoon luteinizing ah, kaas oo isna kicin kara xiniinyaha si loo soo saaro androgens. Cudurka 'LHRH agonists', sida jirka LHRH, wuxuu marka hore kiciyaa soo saarista hoormoonka luteinizing. Si kastaba ha noqotee, sii joogitaanka heerarka sare ee agonistayaasha LHRH ayaa dhab ahaantii sababa qanjirka 'pituitary gland' inuu joojiyo soo saarista hoormoonka luteinizing, natiijada baaritaanka xiniinyaha lama kicinayo inay soo saaraan androgens
Daaweynta LHRH agonist waxaa lagu magacaabaa daaweyn caafimaad ama tuurista kiimikada maxaa yeelay waxay isticmaashaa daawooyin si ay u gaarto wax la mid ah qalitaanka qalliinka (orchiechtomy). Laakiin, si ka duwan orchiectomy, saameynta daawooyinkan ay ku leeyihiin wax soo saarka androgen waa dib loo laaban karaa. Marka daaweynta la joojiyo, wax soo saarka androgen badanaa wuu dib u bilaabmaa.
Cudurka 'LHRH agonists' waxaa lagu siiyaa irbad ama waxaa lagu beeray maqaarka hoostiisa. Afar dhakhaatiirta 'LHRH agonists' ayaa loo oggolaaday inay daweeyaan kansarka qanjirka 'prostate' ee Mareykanka: leuprolide, goserelin, triptorelin, iyo histrelin.
Markay bukaanku helaan dhakhaatiirta 'LHRH agonist' markii ugu horeysay, waxay la kulmi karaan dhacdo la yiraahdo "testosterone flare." Kordhintan kumeelgaarka ah ee heerka testosterone waxay dhacdaa maxaa yeelay LHRH agonists waxay si kooban u keentaa qanjirka 'pituitary gland' inuu qarsado hormoon dheeri ah oo luteinizing ka hor inta uusan xannibaadda sii deyntiisa. Ololka ayaa laga yaabaa inuu ka sii daro astaamaha caafimaad (tusaale ahaan, xanuunka lafaha, kaadi mareenka ama kaadiheysta xanibaada, iyo isku xoqida laf-dhabarka), taas oo dhibaato gaar ah ku noqon karta ragga qaba kansarka qanjirka 'prostate'. Kordhinta testosterone badanaa waa laga hortagayaa iyadoo la siinayo nooc kale oo daaweyn hoormoon ah oo loo yaqaan 'antiandrogen therapy' oo ay weheliso agonist LHRH toddobaadyada ugu horreeya ee daaweynta.
- Daawooyinka loo yaqaan 'LHRH antagonists', oo ah nooc kale oo daaweyn caafimaad ah. LHRH antagonists (sidoo kale loo yaqaan 'GnRH antagonists') waxay ka hortageysaa LHRH inay ku xirnaato qabqablayaasheeda qanjirka 'pituitary gland'. Tani waxay ka hortagtaa dheecaanka hoormoonka luteinizing, kaasoo joojiya xiniinyaha inuu soo saaro androgens. Si ka duwan sida loo yaqaan 'LHRH agonists', LHRH antagonists ma keenaan xanaaqa testosterone.
Mid ka mid ah LHRH antagonist, degarelix, ayaa hadda loo oggolaaday in lagu daweeyo kansarka qanjirka 'prostate' ee hormarsan ee Mareykanka. Waxaa lagu bixiyaa cirbad.
- Estrogens (hormoonno kor u qaada astaamaha galmada dumarka). In kasta oo estrogens ay sidoo kale awoodaan inay joojiyaan soosaarka androgen ee xiniinyaha, hadana dhif ayaa maanta loo isticmaalaa daaweynta kansarka qanjirka 'prostate' sababtoo ah waxyeelooyinkooda.
Daawooyinka xannibaya ficil celinta androgens ee jirka (oo sidoo kale loo yaqaan daaweynta antiandrogen) ayaa caadi ahaan la isticmaalaa marka ADT ay joojiso shaqada. Daaweynta noocan ah waxaa ka mid ah:
- Xannibaadayaasha xayiraadaha Androgen (oo sidoo kale loo yaqaan 'androgen receptor antagonists'), kuwaas oo ah daawooyin la tartamaya androgens si loogu xidho daaweeyaha androgen. Adoo ku tartamaya ku xirnaanshaha qalliinka androgen, daaweyntani waxay yareyneysaa awoodda androgens si kor loogu qaado koritaanka unugyada kansarka qanjirka 'prostate'.
Sababtoo ah xannibaadaha xasaasiyadeed ee androgen ma xannibaan wax soo saarka androgen, si dhif ah ayaa loo iskiis u isticmaalaa si loogu daaweeyo kansarka qanjirka 'prostate'. Taabadalkeed, waxaa loo adeegsadaa isku dhafka ADT (ama orchiectomy ama agonist LHRH). Isticmaalka xayiraadaha xasaasiyadeed ee xiniinyaha ee isku dhafan ama orchiectomy ama agonist LHRH waxaa loogu yeeraa xannibaadda qufulan ee isku-dhafan, xannibaadda androgen oo dhammaystiran, ama wadarta xannibaadda androgen.
Xannibaadayaasha hormoonka xanibaadayaasha 'Androgen receptor blockers' ee laga ogolaaday Mareykanka si loo daweeyo kansarka qanjirka 'prostate' waxaa kamid ah flutamide, enzalutamide, apalutamide, bicalutamide, iyo nilutamide. Waxaa loo siiyay kiniinno la liqo.
Daaweynta xannibaya soo saarida androgens jirka oo dhan waxaa ka mid ah:
- Xannibaadayaasha 'Androgen synthesis inhibitors', oo ah daawooyin ka hortaga soo saaridda androgens-ka qanjidhada adrenal iyo unugyada kansarka qanjirka 'prostate' laftooda, iyo sidoo kale xiniinyaha. Midkoodna daaweyn caafimaad iyo mid qalliin midna kama hor istaagayo qanjidhada adrenal iyo unugyada kansarka qanjirka 'prostate' inay soo saaraan androgens. In kasta oo xaddiga androgens-ka unugyadan soo saaraan ay yar yihiin, way ku filnaan karaan inay taageeraan koritaanka kansarrada qanjirka 'prostate' qaarkood.
Xakameeyayaasha xinjirooyinka 'Androgen synthesis' waxay hoos u dhigi karaan heerarka testosterone ee jirka nin ilaa xad ka badan daaweynta kale ee la yaqaan. Daawooyinkani waxay xayiraan wax soo saarka testosterone iyagoo xakameynaya enzyme loo yaqaan 'CYP17'. Enzyme-kan, oo laga helo unugyada xiniinyaha, adrenal, iyo unugyada burooyinka qanjirka 'prostate', ayaa lagama maarmaan u ah jirka inuu soo saaro testosterone ka kolestaroolka.
Seddex ka hortageyaal isku-dhaf ah oo loo yaqaan 'androgen synthesis inhibitors' ayaa laga ansixiyay Mareykanka: abiraterone acetate, ketoconazole, iyo aminoglutethimide. Dhammaantood waxaa loo siiyay kiniinno la liqo.
Abiraterone acetate waa la ansixiyay iyadoo la raacayo prednisone si loo daaweeyo kansarka qanjirka 'prostate' ee halista sare leh iyo kansarka qanjirka 'prostate prostate'. Kahor ansixinta abiraterone iyo enzalutamide, laba daawo oo loo ansixiyay tilmaamo aan ka aheyn kansarka qanjirka 'prostate cancer-ketoconazole iyo aminoglutethimide-ayaa mararka qaar loo isticmaalay astaan ka baxsan sida daaweyn labaad oo loogu tala galay kansarka qanjirka' prostate '.
Sidee loo isticmaalaa daaweynta hoormoonka daaweynta kansarka qanjirka 'prostate'?
Daaweynta hormoonka waxaa loo isticmaali karaa dhowr siyaabood oo lagu daaweeyo kansarka qanjirka 'prostate', oo ay ka mid yihiin:
Marxaladda hore ee kansarka qanjidhka kaadi mareenka oo leh heer dhexe ama halis sare oo soo noqnoqosho ah. Ragga qaba kansarka qanjirka 'prostate' ee heer dhexe ama halista sare ee soo noqoshada badanaa waxay helayaan daaweynta hoormoonka ka hor, inta lagu jiro, iyo / ama ka dib daaweynta shucaaca, ama waxaa laga yaabaa inay helaan daaweynta hoormoonka ka dib qanjirka 'prostatectomy' (qalliinka looga saarayo qanjirka 'prostate') (6) . Waxyaabaha loo isticmaalo in lagu ogaado halista kansarka qanjirka 'prostate' ee soo noqnoqda waxaa ka mid ah darajada burooyinka (sida lagu qiyaaso dhibcaha Gleason), xaddiga ay buro ku fiday unugyada ku xeeran, iyo in unugyada burooyinka laga helo qanjidhada u dhow inta lagu jiro qalliinka.
Dhererka daaweynta ee ku saabsan daaweynta hoormoonka ee marxaladda hore ee kansarka qanjirka 'prostate' waxay kuxirantahay halista nin ee soo noqoshada. Ragga qaba kansarka qanjirka 'prostate' ee halista ah, daaweynta hoormoonka guud ahaan waxaa la siiyaa muddo 6 bilood ah; ragga qaba cudurka halista badan guud ahaan waxaa la siiyaa 18-24 bilood.
Ragga leh daaweynta hoormoonka ka dib qanjirka 'prostatectomy' ayaa sii noolaanaya iyaga oo aan dib u soo noqnoqonin marka loo eego ragga keligood leh qanjirka 'prostatectomy', laakiin guud ahaan ma sii noolaadaan (6). Ragga leh daaweynta hoormoonka ka dib daaweynta shucaaca ee shucaaca dibadda ama khatarta sare ee kansarka qanjirka 'prostate' ayaa sii noolaan doona muddo dheer, guud ahaan iyo dib u soo noqosho la'aan, marka loo eego ragga lagu daaweeyo shucaaca keligood ah (6, 7). Ragga qaata daaweynta hoormoonka ee lagu daro daaweynta shucaaca sidoo kale waxay ka cimri dheer yihiin guud ahaan ragga qaata daaweynta shucaaca kaligood (8). Si kastaba ha noqotee, waqtiga ugu fiican iyo muddada ADT, kahor iyo kadib daaweynta shucaaca, lama dhisin (9, 10).
Isticmaalka daaweynta hoormoonka (kaligiis ama lagu daro kemotherabi) kahor qanjirka 'prostatektomi' looma muujin inuu sii dheereynayo jiritaanka mana aha daaweyn caadi ah. Xannibaad xoog leh oo xannibaad ah ka hor qanjirka 'prostatectomy' ayaa lagu baranayaa tijaabooyinka bukaan socodka.
Cudurka qanjirka 'prostate' ee soo noq noqday / soo noqnoqda Daaweynta hoormoonka kaligeed la isticmaalo ayaa ah daaweynta caadiga ah ee loogu talagalay ragga qaba kansarka qanjirka 'prostate cancer' sida ay diiwaangelisay CT, MRI, ama baaritaanka lafaha ka dib daaweynta daaweynta shucaaca ama qanjirka 'prostatectomy'. teraabiyada ayaa mararka qaarkood lagula taliyaa ragga leh "soo-noqoshada kiimikada" soo noqnoqoshada — kor u kaca heerka antigen-ka qaaska ah ee qanjirka 'prostate' (PSA) ka dib daaweynta asaasiga ah ee qalliinka ama shucaaca — gaar ahaan haddii heerka PSA uu labanlaabmayo wax ka yar 3 bilood kansarkuna uusan lahayn faafitaan.
Tijaabo caafimaad oo la kala soocay oo ragga ah oo soo noqnoqda biochemical ka dib markii qanjirka 'prostatectomy' lagu ogaaday in ragga heysta daaweynta antiandrogen ee lagu daray daaweynta shucaaca ay u dhowdahay inay yeeshaan metastases ama u dhintaan kansarka qanjirka 'prostate' ama guud ahaan ragga leh placebo oo lagu daray shucaac (11). Si kastaba ha noqotee, bukaanada leh qiime hoose PSA uma muuqan inay ka faa'iideysanayaan ku darista daaweynta hormoonka shucaaca. Tijaabo kale oo caafimaad oo dhowaan la sameeyay ayaa muujisay in ragga leh heerarka PSA ee sii kordhaya ka dib daaweynta aasaasiga ah ee maxalliga ah ee halista sare ugu jira metastasis laakiin aan lahayn wax caddeyn ah oo ku saabsan cudurka metastatic, ku darista daaweynta kiimikada ee docetaxel ilaa ADT kama sarreynin ADT marka la eego dhowr tallaabo oo badbaado ah ( 12)
Kansarka qanjirka 'prostate' ee horumarsan ama kan sare leh. Daaweynta hoormoonka kaligeed la isticmaalo ayaa ah daaweynta caadiga ah ee loogu talagalay ragga lagu arko inay qabaan cudurka metastatic (ie, cudur ku faafay qaybaha kale ee jirka) marka kansarkooda qanjirka 'prostate' markii ugu horreysay la ogaado (13). Tijaabooyinka caafimaad waxay muujiyeen in ragga noocaas ahi ay sii noolaadaan waqti dheer markii lagu daweeyo ADT oo lagu daray abiraterone / prednisone, enzalutamide, ama apalutamide marka loo eego marka lagu daaweeyo ADT oo keliya (14-17). Si kastaba ha noqotee, sababtoo ah daaweynta hoormoonka waxay yeelan kartaa waxyeelo la taaban karo, ragga qaarkood waxay doorbidaan inaysan qaadan daaweynta hoormoonka illaa astaamaha ay soo baxaan.
Natiijooyinka ugu horreeya ee tijaabinta ay NCI maalgelisay ee ay sameeyeen laba koox oo iskaashatooyin kansar ah - Kooxda Iskaashatada Oncology ee Bariga (ECOG) iyo Kulliyadda Maraykanka ee Shabakadda Sawirka Raajada (ACRIN) - ayaa lagu taliyay in ragga qaba kansarka qanjirka 'prostate' ee qaata hormoonka xasaasiga ah. dawada kimikal daweynta docetaxel bilawga daaweynta caadiga ah ee hoormoonka waxay ka cimri dheer tahay ragga keligood qaata daaweynta hoormoonka. Ragga qaba cudurka ugu badan ee dheef-shiid kiimikaadka ayaa u muuqday inay si aad ah uga faa'iideystaan isku-darka hore ee docetaxel. Natiijooyinkaan waxaa dhowaan lagu xaqiijiyay dabagal dheer (18).
Daweynta astaamaha. Daaweynta hormoonka waxaa mararka qaarkood loo isticmaalaa kali ah ama ka hortagga astaamaha maxalliga ah ee ragga qaba kansarka qanjirka 'prostate' ee aan u tartamin qalliinka ama daaweynta shucaaca (19). Ragga noocan oo kale ah waxaa ka mid ah kuwa rajadooda nololeed ay xaddidan tahay, kuwa burooyinka maxalliga ah ee hormarsan, iyo / ama kuwa leh xaalado caafimaad oo kale oo daran.
Daar faallada is cusboonaysiinta