荷尔蒙疗法失败之转移性前列腺癌诊疗指引及-中山医学大学附设医院.PDF

癌症診療指引簡介及臨床應用 荷爾蒙療法失敗之轉移性前列腺癌診療指引 及最新治療方法簡介 Introduction of Guideline and Novel Treatment Modalities in The Management of Metastatic Castration-Resistant Prostate Cancer (mCRPC) 中山醫學大學附設醫院泌尿科 王紹全醫師 Date: March 29, 2014, AM 08:00 ~ 08:50 Venue ：正心樓0211教室 1 Age 59 60~74 75 Sum New Dx 281(7.5%) 1651(44.4%) 1787(48.1%) 3719 Any ADT 39.51% 48.15% 67.94% 57.01% Refine of Definition of Castration-Resistant Prostate Cancer # Patients with advanced prostate cancer treated with androgen deprivation therapy (ADT) will eventually experience disease progression. # Castration-resistant prostate cancer (CRPC) is defined as: – Progressive prostate cancer (rising PSA, radiographic progression) – With serum testosterone below castrate levels ( 0.50 ng/mL) # Evidence revealed 2nd hormonal agents, e.g. anti-androgens, ketoconazole, estrogens and several newer agents meet clinical response in patients who are ‘refractory’ to ADT. - Receptor overexpression/amplification - Androgen receptor (AR) mutations (e.g. receptor hypersensitivity) - Increased AR ligand synthesis - AR co-activators and chaperones - Ligand-independent AR activation Garcia JA and Rini BI. Cancer 2012;118:2583–2593. Scher HI, et al. Endocr Relat Cancer 2004;11:459–476; Garcia JA and Rini BI. Cancer 2012;118:2583–2593 Taylor CD, et al. J Clin Oncol 1993;11:21