雄激素拮抗剂和前列腺癌幻灯片1.pptVIP

孙颖浩 上海长海医院泌尿外科;前列腺癌激素治疗;雄激素拮抗剂的作用机制（一）－雄激素和雄激素受体; testosterone enters the cell and is reduced to 5αdihydrotestosterone (DHT) by 5α-reductase.DHT binds to the androgen receptor, and the complex moves into the nucleus, where transcription control of Androgen dependent genes occurs. ;抗雄激素药物的分类－Pure Antiandrogens and Steroidal Antiandrogens ;抗雄激素药物的内分泌作用的比较;前列腺癌激素治疗方式对血睾酮的影响; 问题（一） 雄激素拮抗剂单药应用与手术去势、药物去势相比效果如何？; Seidenfled对MEDLINE, Cancerlit, EMBASE, Cochrane Library databases 等几个数据库中1966年3月－1998年8月共1477篇文献，6600名患者的数据统计分析结果如图：;结论（一）：;结论（二）;结论（三）; 问题（二） 去势后前列腺癌复发加用雄激素拮抗剂效果如何？; Fujikawa对手术去势或药物去势的前列腺癌复???患者，加用氟他胺，结果表明：那些在手术或药物去势治疗后，PSA水平降至4ng/ml水平的前列腺癌患者，前列腺癌复发后加用氟他胺有效。 Fujikawa K，Prostate-specific antigen levels and clinical response to flutamide as the second hormone therapy for hormone-refractory prostate carcinoma.Eur Urol. 2000 Feb;37(2):218-22. ; 问题（三） MAB中的雄激素拮抗剂;1、Maximal androgen blockade for patients with metastatic prostate cancer: outcome of a controlled trial of bicalutamide versus flutamide, each in combination with luteinizing hormone-releasing hormone analogue therapy. Casodex Combination Study Group. Urology. 1996 Jan;47(1A Suppl):54-60; discussion 80-4. 2、Clinical benefits of bicalutamide compared with flutamide in combined androgen blockade for patients with advanced prostatic carcinoma: final report of a double-blind, randomized, multicenter trial. Casodex Combination Study Group. Urology. 1997 Sep;50(3):330-6. 3、A controlled trial of bicalutamide versus flutamide, each in combination with luteinizing hormone-releasing hormone analogue therapy, in patients with advanced prostate cancer. Casodex Combination Study Group. Urology. 1995 May;45(5):745-52. 4、A controlled trial of Casodex (bicalutamide) vs. flutamide, each in combination with luteinising hormone-releasing hormone analogue therapy in patients with advanced prostate cancer. Casodex Combination Study Group. Eur Urol. 1996;29 Suppl 2:105-9.; 问题（四） 雄激素拮抗剂撤退综合征;