激素抵抗性前列腺癌的治疗新进展

晚期前列腺癌患者一般采用姑息性内分泌治疗,而这种治疗方式往往在2～3年后即因为雄激素抵抗失去疗效。本文就目前对激素抵抗性前列腺癌(HRPC)的几种治疗方法化疗、放疗、靶向治疗、疫苗及基因治疗等最新进展作一综述。     

激素抵抗性前列腺癌分子靶向治疗的研究进展

大多数初始对激素治疗敏感的前列腺癌病人都会转变为激素抵抗性前列腺癌(CRPC),病情从而迅速恶化以至死亡.分子靶向治疗因为其对前列腺癌生物学行为的特异作用,为CRPC的治疗提供了一个新的方向.目前的分子靶向研究主要以多西他赛(DOC)为基础,联合一种或多种靶向药物进行.     

前列腺癌基因治疗研究进展

前列腺癌的基因治疗可采用病毒或非病毒载体，通过不同的途径将治疗基因导入前列腺癌细胞，从而在基因水平上治疗前列腺癌。本文就近年来前列腺癌基因治疗研究中的基因转移途径、各种载体、治疗策略、临床取得的成果和目前存在的问题作一综述。     

前列腺癌的基因治疗进展

用常规方法治疗前列腺癌预后不佳，近年来随着对癌症分子作用机制研究的深入，给临床医生提供了用基因方法治疗肿瘤的机会。本文综述了近年来前列腺癌基因治疗几种策略的研究进展。     

前列腺癌基因治疗研究进展

前列腺癌的基因治疗可采用病毒或非病毒载体,通过不同的途径将治疗基因导入前列腺癌细胞,从而在基因水平上治疗前列腺癌。本文就近年来前列腺癌基因治疗研究中的基因转移途径、各种载体、治疗策略、临床取得的成果和目前存在的问题作一综述。     

前列腺癌基因治疗的研究进展

由于前列腺癌对常规的手术、药物和放射治疗效果不佳 ,基因治疗成为前列腺癌研究的新热点 ,并初见功效。了解基因矫正治疗、细胞减数基因治疗和免疫调制基因治疗三方面对前列腺癌基因治疗的机制和进展 ,为从事前列腺癌基因治疗的研究者提供有价值的参考。     

前列腺癌的基因治疗进展

用常规方法治疗前列腺癌预后不佳 ,近年来随着对癌症分子作用机制研究的深入 ,给临床医生提供了用基因方法治疗肿瘤的机会。本文综述了近年来前列腺癌基因治疗几种策略的研究进展。     

前列腺癌基因治疗的现状和展望

前列腺癌已成为基因治疗的研究热点，治疗策略分为修正基因疗法和细胞减数和溶细胞基因疗法。本文就前列腺癌基因治疗的现状以及未来的发展趋势作一综述。     

前列腺癌基因治疗的现状和展望

前列腺癌已成为基因治疗的研究热点,治疗策略分为修正基因疗法和细胞减数和溶细胞基因疗法。本文就前列腺癌基因治疗的现状以及未来的发展趋势作一综述。     

前列腺癌激素治疗时机的研究进展

激素治疗作为前列腺癌的—项重要治疗方法，并不能确切延长患者的生存期，并且往往伴有诸多副反应，目前围绕前列腺癌激素治疗时机的争论主要集中在对进展期前列腺癌进行早期激素治疗能否优于等到转移灶出现或症状进展时才进行治疗。以长期总体生存率作为指标来比较，早期治疗与延迟治疗并无明显差异；相反以疾病进屁率成无瘤生存率作为指标来比较，早期的辅助激素治疗对有选择的患者有明显的益处。     

Combination therapy with estramustine and docetaxel for hormone refractory prostate cancer

Six patients with hormone refractory prostate cancer were orally administered 560 mg of Estramustine daily in 2 equally divided doses for four or five days. In addition 70 mg/m2 of Docetaxel was infused through intravenous drip from day 1, decreasing to 40-60 mg/m2 if any side effects such as bone marrow depression were observed. One cycle was three weeks in hospital and one month after discharge. Patients were treated until progression or the development of treatment-limiting toxicity. In five of the six patients (83.3%), serum prostate specific antigen (PSA) was decreased by more than 50%. Currently, this therapy is ongoing in four outpatients. A side effect of leucopenia (grade 2 or 3) was observed in all patients. Granulocyte-colony stimulating factor (G-CSF) formulation was given as treatment. One case was withdrawn due to loss of appetite after one cycle. This therapy is considered to be effective against hormone refractory prostate cancer. However, further examination is needed about dosage and dosing regimen of Estramustine and Docetaxel.     

Chemotherapy for hormone refractory prostate cancer.

New combinations have been developed that show significant activity in therapy for hormone refractory prostate cancer. Several of these are designed to address specific cellular targets unique to prostate cancer. To date, the major benefits of these therapies have been palliative in nature, resulting in an improvement in quality of life, particularly with the combination of mitoxantrone and prednisone. None of these agents or regimens have been shown to affect survival significantly, and none can be considered to be standard therapy for this disease. Nonetheless, the success of these regimens in inducing response has challenged the skepticism concerning the appropriateness of chemotherapy for patients with advanced prostate cancer. The ability to slow and even reverse the growth of far advanced disease raises the possibility that the application of these regimens earlier in the course of the disease will have a more significant impact on the morbidity and, in the long run, on the mortality of prostate cancer. It is hoped that the enrollment of patients into properly designed clinical trials of new agents and combinations will result in the development of therapy with proven efficacy in the near future.     

Gene therapy for prostate cancer

The treatment options for the patient with advanced prostate cancer are limited. Due to the recent advances in the understanding of the molecular biology of prostate cancer, the easy accessibility of the gland for injection, and the availability of gene promoters that can provide tissue specific expression of therapeutic gene sequences, gene therapy for prostate cancer is rapidly advancing. Many potential approaches for prostate cancer gene therapy have been identified, with a few of these already entering Phase I clinical trials. This review will discuss the basis of prostate cancer gene therapy, look at the potential approaches, and will compare the different vectors that can be used to deliver the therapeutic genes to the prostate tumor.     

Gene therapy for prostate cancer

The substantial advances made in recent years in the molecular biology of malignant urological tumors and the associated progressive analysis of these conditions at a molecular level have spurred research aimed at gene-based treatment. In the field of prostate cancer, while there have been many ground-breaking studies particularly in the United States, none has yet led to a revolutionary treatment for recurrent prostate cancer. Gene-based treatment is being applied seriously in clinical settings, especially in the United States, but so far without significant effect. Many researchers worldwide are devoting energy to the development of effective vectors. By adjusting the promoter, which has the function of directing the vector, we have developed organ-specific vectors for the treatment of prostate cancer. In the present study, which targeted prostate cancer with bone metastasis, we developed a suicide-gene therapy using an adenovirus vector with an organ-specific osteocalcin promoter. Clinical trials of this vector have already been conducted at the University of Virginia in the United States and have so far confirmed the safety of the therapy. In the present paper we present the results of this gene-therapy research from the basic to the clinical phase alongside an outline of related research at our institution. Gene therapy for cancer is now being targeted not only against the primary tumor but systemic cancers including distant metastases; systemic administration of adenovirus vectors with organ-specific promoters may become one of the most promising systemic anti-tumor therapies of the next-generation.     

Gene therapy for prostate cancer

Basic research continues to unravel the molecular complexity of normal and abnormal biologic processes. The development of means to affect the expression level of genes that promote or contribute to cellular transformation, invasion, and metastasis has spawned the concept of gene therapy. This relatively new field seeks to reverse or suspend the pathologic progression of a variety of diseases including the malignant transfor-mation of prostatic epithelial cells. Initial clinical trials for prostate cancer have thus far shown gene therapy to be relatively safe, although definitive evidence of durable therapeutic efficacy remains to be demonstrated. In this article, recent preclinical research, current therapeutic strategies, and recent results of gene therapy clinical trials for the treatment of prostate cancer are reviewed.     

Gene therapy for prostate cancer

In this section there are, as usual, four papers of general interest. The use of gene therapy has become topical, but is in need of further development. Its current status in prostate cancer is updated by the authors from London. In a mini‐review on what is termed ‘hypospadiology’, David Thomas reports on a topic that is one of the most commonly written about in paediatric urology. The authors from Israel review abdominal compartment syndrome, an important complication seen in critically ill patients. Finally, Jim Gillespie introduces us to his interesting views on the origin of the overactive bladder and sensory urgency.     

Treatment of hormone refractory prostate cancer

Prostate cancer is mainly an androgen sensitive disease. The use of androgen ablation can be dated back to Huggins in 1941. Currently patients with localized prostate cancer are managed aggressively and hormonal manipulations are reserved for locally advanced or metastatic disease. When androgen independence has emerged, treatment options are essentially palliative; with the aim of controlling symptoms and maintaining quality of life, and if possible prolonging survival. Following the failure of primary androgen ablation, a number of treatment strategies are available. Exploitation of the anti‐androgen withdrawal syndrome and using second or third line hormonal therapies are well established treatments. Interest in chemotherapy has been revived owing to demonstrable benefits in prostate‐specific antigen response and pain palliation, albeit without definite improvements in survival. An increased understanding of the molecular biology of prostate cancer has led to the identification of novel agents that may prolong survival while maintaining quality of life. Ongoing clinical trials are designed for assessment of these agents, with the view of adding them to our armamentarium against prostate cancer.