子宫内膜异位症术后使用GnRH-a的临床疗效观察

目的:观察腹腔镜术后辅助GnRH-a治疗子宫内膜异位症的临床疗效,探讨治疗子宫内膜异位症的最佳治疗方案。方法:选择采用腹腔镜治疗术后确诊为子宫内膜异位症患者185例,按照自愿的原则分为对照组与观察组,对照组90例术后未采用辅助治疗,观察组95例术后辅助GnRH-a治疗12个月后比较两组患者治疗前后生殖激素水平变化、临床疗效及妊娠率。结果:治疗12个月后,两组患者生殖激素水平、临床疗效方面比较差异有统计学意义(P<0.05),而妊娠率两组间差异无统计学意义(P>0.05)。结论:腹腔镜治疗子宫内膜异位症后辅助GnRH-a治疗,可提高临床疗效、减少复发,但不能提高妊娠率。     

丘脑-垂体-性腺轴调节睾酮合成的研究进展

睾酮是一种重要的雄激素,主要来源于睾丸间质细胞。睾酮在机体内具有重要的生理作用：维持生殖功能及第二性征,增强肌肉强度与质量,维持骨密度等。睾丸间质细胞生成睾酮主要受丘脑-垂体-性腺轴（HPGA）的调节,下丘脑促性腺激素释放神经元受到来自神经系统单胺类递质等神经肽信号,经特定转录因子、辅酶因子等物质的刺激,合成并分泌促性腺激素释放激素（GnRH）,GnRH经门脉循环作用于垂体前叶,促进黄体生成素（LH）、卵泡刺激素（FSH）的合成与分泌。其中LH作用于睾丸Leydig细胞,经过多种类固醇激素合成酶的作用,最终将游离的胆固醇转化为睾酮。本文对HPGA中主要调节因素特别是分子调控机制的研究进展进行了综述。     

多西紫杉醇治疗激素非依赖性前列腺癌临床研究新进展

预后较差的激素非依赖性的前列腺癌,目前的治疗方法主要是化疗.米托蒽醌和雌莫司汀都是已经FDA批准的可以用于治疗前列腺癌的化疗药物.两种药物与单用激素相比,未延长患者的生存时间.2004年全美临床肿瘤年会(ASCO)上,报告了两项多西紫杉醇联合化疗治疗激素难治性前列腺癌的临床研究,结果显示能明显改善生存.     

什么是前列腺癌的雄激素去除治疗

由于前列腺是雄激素依赖器官，大多数前列腺癌是雄激素依赖性的，也就是体内雄激素可以促使前列腺癌进一步恶化进展，而去除体内的雄激素可以使前列腺癌病变和症状明显缓解。双侧睾丸切除术可使体内雄激素大幅度减少，从而控制前列腺癌的发展，但是因为有手术创伤和心理影响，以及不可逆性，国内外多不主张采用。国内外多主张采用黄体生成素释放激素促效剂，如抑那通、诺雷德、达菲林等。可使血中雄激素浓度下降达到睾丸切除水平，即“药物切睾”。     

前列腺癌患者血清睾酮水平、前列腺雄激素受体表达与精索静脉曲张相关研究

目的：研究血清睾酮水平、前列腺雄激素受体（AR）表达与精索静脉曲张的相关性,为临床前列腺疾病诊治提供一定理论依据。方法选取未经药物治疗的64例前列腺癌患者,其中实验组为32例前列腺癌合并精索静脉曲张患者,对照组为32例前列腺癌不伴精索静脉曲张患者,记录两组患者一般情况,并行血清睾酮水平、前列腺雄激素受体检测及病理组织学检查。结果对照组血清睾酮水平为（5.89±1.32）ng/ml,实验组血清睾酮值为（6.07±1.16）ng/ml,差异无统计学意义（P﹥0.05）。实验组前列腺雄激素受体的阳性表达率为62.5%,低于对照组84.4%,差异有统计学意义（P﹤0.05）。AR的表达均与伴精索静脉曲张前列腺癌分期呈负相关（r=-0.318, P﹤0.05）。结论前列腺雄激素受体表达在前列腺癌精索静脉曲张的发病及病情进展中发挥了重要的作用。     

前列腺癌患者雄激素剥夺治疗后的代谢营养问题

前列腺癌是男性最常见的恶性肿瘤之一，雄激素剥夺治疗是前列腺癌一线治疗方案。长时间雄激素剥夺治疗前列腺癌患者持续处于雄激素低下状态会出现一系列代谢和营养问题，比如肥胖、糖尿病、脂肪代谢异常、代谢综合征、心血管疾病风险增加等，严重影响患者生活质量、肿瘤序列治疗的进行和预后。但相关针对性研究较少，本文对长时间雄激素剥夺治疗前列腺癌患者的代谢和营养问题，就肥胖、糖尿病、血脂异常以及代谢综合征几个方面，进行深入讨论并对相关研究进行展望。     

雄激素剥夺疗法和免疫疗法在前列腺癌治疗中的研究进展

前列腺癌在美国成年男性中发病率位居第一,癌症相关致死率位居第二。雄激素剥夺治疗是最常用的前列腺癌治疗方法,而且通常伴随患者的终身治疗。雄激素和雄激素剥夺疗法对免疫系统有着重要的影响,在目前免疫治疗受到持续关注的情况下这一发现显得尤为重要。研究表明,雄激素剥夺治疗可能对免疫治疗起到促进或者抑制的作用。本文综述了不同类型雄激素剥夺治疗药物的作用机制,探讨了其对前列腺癌细胞及患者免疫系统的影响,以及联合使用雄激素剥夺药物和免疫治疗的前景,为前列腺癌的治疗提供了新的视野和思路。     

GnRH-a联合LNG-IUS对子宫内膜异位症Ⅲ-Ⅳ期患者术后疼痛的疗效

目的:探讨促性腺激素释放激素激动剂（GnRH-a）联合左炔诺孕酮宫内缓释系统（LNG-IUS）对子宫内膜异位症Ⅲ-Ⅳ期患者术后疼痛的治疗效果。方法:回顾性分析100例已行保守性腹腔镜手术的子宫内膜异位症Ⅲ-Ⅳ期患者,给予GnRH-a联合LNG-IUS治疗的患者50例(实验组);给予单纯GnRH-a治疗的患者50例(对照组)。术后6个月、12个月随访患者疼痛评分（VAS法,B&B法）。结果:两组内术后6个月、12个月VAS、B&B评分显著低于术前(P＜0.05)。对照组术后12个月VAS、B&B评分显著高于术后6个月(P＜0.05)。实验组术后12个月VAS、B&B评分显著低于对照组(P＜0.05)。结论:GnRH-a联合LNG-IUS对腹腔镜保守性手术术后子宫内膜异位症Ⅲ-Ⅳ期患者的疼痛治疗作用确切、长效,值得临床推广。     

促性腺激素释放激素类似物在上皮性卵巢癌治疗中的应用

促性腺激素释放激素类似物（GnRHa）N以通过抑制下丘脑一垂体一性腺轴间接抑制卵巢癌的发生发展,也可以通过癌细胞表达的GnRHR介导,直接抑制癌细胞的增殖、诱导凋亡等。GnRHa还可以运用对肿瘤细胞的靶效应,作为载体连接上细胞毒性药物,可以提高细胞毒性药物的功效、降低不良反应。因此,GnRHa对部分顽固性复发性卵巢癌有一定疗效。文章主要对GnRHa在上皮性卵巢癌治疗中的应用进行综述。     

The role of androgen deprivation therapy plus radiation therapy in patients with non-metastatic prostate cancer

Introduction: Androgen deprivation therapy (ADT) has a long and illustrious history in the treatment for prostate cancer and continues to be a mainstay treatment for locally advanced and high-risk patients. Because the survival for even high-risk prostate patients is lengthy, details of treatment such as duration and timing must be considered carefully and weighed against the various side effects.

Areas covered: In the following article, we discuss the evolution of ADT from its initial applications in metastatic prostate cancer to its more recent incorporation into front line treatment in conjunction with radiation therapy (RT) for intermediate and high risk disease. We emphasize the results of phase III trials, which have defined the role of ADT in combination with RT in this patient population. We emphasize not only the potential benefits of ADT with RT, but also the potential risks, and underscore the need to consider both in order to maximize the therapeutic ration for each patient. Studies were identified via a search of PubMed as well as the bibliographies of articles discussed herein.

Expert commentary: Even with advanced radiation techniques and dose escalation, adjuvant ADT continues to confer an overall survival benefit in intermediate and high-risk patients, although some evidence suggest that duration of treatment may be shortened, particularly for the high-risk group. The coming years will shed further information on this complicated topic with maturing of results from several ongoing trials.     

Osteoporosis and other adverse body composition changes during androgen deprivation therapy for prostate cancer

Osteoporosis and other body composition changes are important complications of androgen deprivation therapy (ADT) for prostate cancer. Bilateral orchiectomy and gonadotropin-releasing hormone agonist treatment decrease bone mineral density and increase fracture risk. Other factors including diet and lifestyle may contribute to bone loss in men with prostate cancer. Estrogens play an important role in male bone metabolism. Androgen deprivation therapy with estrogens probably causes less bone loss than bilateral orchiectomy or gonadotropin-releasing hormone agonist treatment. Bicalutamide monotherapy increases serum estrogen levels and may also spare bone. Lifestyle modification including smoking cessation, moderation of alcohol use, and regular weight bearing exercise are recommended to decrease treatment-related bone loss. Supplemental calcium and vitamin D are also recommended. Pamidronate (Aredia®), an intravenous bisphosphonate, prevents bone loss during ADT. Other bisphosphonates are probably effective but have not been studied in hypogonadal men. Androgen deprivation therapy increases fat mass and decreases muscle mass. These body composition changes may contribute to treatment-related decreases in physical capacity and quality of life.     

Bisphenol A may reduce the efficacy of androgen deprivation therapy in prostate cancer

Individuals diagnosed with specific diseases may represent subpopulations with heightened sensitivity to environmental compounds. This may be due to their disease-mediated molecular milieu and/or the interference of environmental compounds with pharmaceutical drug targets. Prostate cancer represents a significant clinical challenge in the United States. If the disease becomes advanced, standard therapies are ineffective, leading to high rate of patient morbidity and mortality. Understanding the complex reasons for therapeutic resistance is critical for improving the life expectancy for patients with this cancer. Recently, it has been identified that common somatically derived genetic mutations that arise following the selective pressure of standard prostate cancer treatments may facilitate sensitivity to environmental contaminants. These somatic mutations within the androgen receptor allow the estrogen mimic, bisphenol A (BPA), to bind and activate the receptor, resulting in increased proliferation and tumor growth in the presence of the traditional therapy regimen for prostate cancer. In an in vivo xenograft model of prostate cancer, low level exposure of BPA was sufficient to reduce the efficacy of treatment. Herein, the possible effect of BPA on prostate cancer treatment and disease management for humans is explored as an example of environmental endocrine disruptor exposure reducing the efficacy of disease management. These data lend support to the hypothesis that environmental exposure to select compounds may interfere with specific therapeutic regimens.     

A comprehensive bone-health management approach for men with prostate cancer receiving androgen deprivation therapy

For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay of treatment. Awareness of the potential bone-health complications consequent to adt use is increasing. Many studies have shown that prolonged adt leads to significant bone loss and increased fracture risk that negatively affect quality of life. Clinical practice guidelines for preserving bone health in men with prostate cancer on adt vary across Canada. This paper reviews recent studies on bone health in men with prostate cancer receiving adt and the current evidence regarding bone-health monitoring and management in reference to Canadian provincial guidelines. Based on this narrative review, we provide general bone-health management recommendations for men with prostate cancer receiving adt.     

联合雄激素阻断治疗前列腺癌所致贫血的研究

目的　研究联合雄激素阻断治疗对前列腺癌患者血红蛋白 (Hb)和红细胞压积 (Ht)的影响。方法　 136例前列腺癌患者采用联合雄激素阻断治疗 (睾丸切除 +氟他胺或福至尔 ,2 5 0mg/次 ,3次 /d)。治疗前及治疗后 1,2 ,3,6 ,9和 12个月分别检测患者的Hb和Ht。 6例贫血症状严重的患者采用重组人红细胞生成素 (RHE)治疗。结果　治疗前及治疗后 1,2 ,3,6 ,9和 12个月患者的Hb分别为 :(136± 14 )g/L、(12 6± 16 )g/L、(12 1± 14 )g/L、(12 0± 15 )g/L、(113± 12 )g/L、(12 1± 13)g/L和 (12 3± 15 )g/L ;Ht分别为 :0 .4 2 4± 0 .0 4 1、0 .390± 0 .0 38、0 .381± 0 .0 4 2、0 .378± 0 .0 38、0 .36 6± 0 .0 4 1、0 .0 384± 0 .0 39和 0 .387± 0 .0 4 0。治疗后与治疗前相比 ,差异均有显著性 (P <0 .0 5 )。贫血严重者 ,RHE治疗后贫血症状改善。结论　联合雄激素阻断治疗可导致贫血 ,对此类患者要定期监测Hb及Ht。重组人促红细胞生成素可用于纠正此类贫血。