抑那通治療前列腺癌的新進(jìn)展-課件

抑那通治療前列腺癌的新進(jìn)展抑那通治療前列腺癌的新進(jìn)展AUA(2019)內(nèi)分泌治療新進(jìn)展Radiotherapycombinedwithandrogendeprivationvs.androgendeprivationaloneinclinicallylocallyadvancedprostatecanerinamulticenterrandomisedphaseIIIstudyNicolasMottet,France.AUA(2019)內(nèi)分泌治療新進(jìn)展RadiotherapyAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESInlocallyadvanceddisease,thecombinationofradiotherapy(RT)andandrogendeprivation(ADT)issuperiortoRTalone.ButADTwithananaloguehasneverbeencomparedtocombinedmodality.WereportaphaseIIIrandomisedtrialinlocallyadvancedPCa,comparingacombinedmodalityandADTonly.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSInthisFrenchmulticenter,open,randomisedtrial,patientslessthan80years,withhistologicallyconfirmedPCa,T3-4,orpT3(biopsy)N0M0wereincluded.Theywerecentrallyrandomisedin2parallelgroupstoeitherADTalone(leuprorelin11.25mgSR,1scinjectionevery3monthsfor3yearsorthesameADTcombinedwithRTstartingwithin3monthsover7weeks.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSHTHT+RTPN131133MeanAge70.570.70.63MeanPSAbaseline51.7741.500.79MedianPFS(days)126425440.0005PFS(5year)(%)15.464.70.0005Biologicalprogression(%)71.519.5<0.0001Clinicalprogression(%)37.711.3<0.0001AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSHTHT+RAUA(2019)內(nèi)分泌治療新進(jìn)展Prevalenceofmetabolicsyndromeinprostatecancerpatientsunderandrogendeprivationtherapy:interimresultsofacase-controlstudy.JorgeRopero,Barcelone,Spain.AUA(2019)內(nèi)分泌治療新進(jìn)展PrevalenceofAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESCardiovascularmortalityisthemostimportantcauseofdeathinpatientswithprostatecancer(PC).Thedevelopmentofmetabolicsyndrome(MS)inpatientsundergoingandrogendeprivationtherapy(ADT)hasbeenrelatedwiththisincreaseinmortalityrate.TheaimofthisstudyhasbeentoconfirmthehypothesisthatADTincreasestheprevalenceofMS.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAgroupof157patientswereenrolledinthisinterimanalysisofaprospectivecasecontrolstudy.53PCpatientsunderADTduringameantimeof52months(6to252)and104agematchedcontrolsevaluatedatthetimeofprostatebiopsy(52withcancerand52without)wereincluded.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSMSwasanalyzedaccordingtheATPIIIpanelcriteria:Fastingplasmaglucoselevel>110mg/dLserumtriglyceridelevel>150mg/dLserumhigh-densitylipoproteinlevel<40mg/dLwaistcircumference>102cmBloodpressureof>130/85mmHg.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSMSwasdiagnosedin27ofthe53patientssubjectedtoADT(51.9%)whileitwasdetectedin35ofthe105age-matchedcontrols(33.3%),p=0.020.HowevertheprevalenceofMSwas35.8%(19/53)inmenwithoutPCand30.8%(16/52)inmenwithPC,p=0.365.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAlthoughthelimitednumbercasesandcontrolsincludedinthisinterimanalysis,asignificantincreaseintheprevalenceofMSwasobservedinPCpatientssubjectedtoADT.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAUA(2019)內(nèi)分泌治療新進(jìn)展MetabolicchangeafterandrogendeprivationtherapyinKoreanmenwithprostatecancerChangHooPark,KoreaAUA(2019)內(nèi)分泌治療新進(jìn)展MetabolicchaAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESInmenwithprostatecancer,Androgendeprivationtherapyshowsavarietywellrecognizedmetabolicalteration.TobettercharacterizethemetaboliceffectsofandrogendeprivationtherapyinKoreanmen,weevaluatedthechangesinfatthickness,bonemineraldensity(BMD),bodymassindex(BMI),andlevelsofhemoglobin(Hb)andcholesterol.Wealsocomparedthemwithdatafromhealthysubjects.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSFromDecember2019toDecember2019,148Koreanmentreatedwithleuprolidedepotandbicalutamideforprostatecancerand100healthysubjectswereinvestigatedincludedchangefrombaselinetomonth12infatthickness,bonemineraldensity(BMD),bodymassindex(BMI),andlevelsofhemoglobin(Hb)andcholesterol.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSADTControlPN148100Fatthickness(mm)20.416.9<0.05BMD=bonemineraldensity0.910.94<0.05BMI(kg/m2)23.922.9<0.05Therearenosignificantchangesinhemoglobinandcholesterollevels.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSADTConAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONOurresultsshowthatKoreanmenwithprostatecancerhaveincreasedabdominalsubcutaneousfatandBMIandhavedecreasedBMDduringandrogendeprivationtherapy.Theseincreasestheriskofbonefractureandcomplicationrelatedobesity.Therefore,BMDwillbecheckedperiodicallyandcarryoutexerciseprogramtopreventionobesityduringandrogendeprivationtherapy.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAUA(2019)內(nèi)分泌治療新進(jìn)展Sarcopeniainmenreceivingandrogendeprivationtherapyforprostatecancer:aprospective3-yearstudy.MatthewR.Smith,CA.AUA(2019)內(nèi)分泌治療新進(jìn)展SarcopeniainAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESAndrogendeprivationtherapy(ADT)forprostatecancerdecreasesbonemineraldensityandincreasesfracturerisk.StudieswithlimitedsamplesizeandobservationalperiodshavereportedthatADTisalsoassociatedwithsarcopeniaorlossofmuscle(leanbodymass,LBM).WenowreporttheprospectivechangesinLBMinasubsetofmenfromthatstudy.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSMenundergoingADTfornonmetastaticprostatecancerat38centersinNorthAmericawererandomizedtodenosumaborplacebo.Atotalof248subjects(130denosumab,118placebo)withabaselineandwithatleast1on-studyLBMresultwereconsideredevaluableandincludedinthisanalysis.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSSubjectswerestratifiedatbaselinebyage(<70yearsvs≥70years)andbydurationofADTtreatment(≤6monthsvs>6months).LBMwasmeasuredbytotalbodydual-energyx-rayabsorptiometryatbaselineandat12,24,and36months.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSFrombaselinetomonth12,meanLBMdecreasedsignificantlyby1.0%(p=.0004).SignificantdecreasesinLBMwerealsoobservedatmonth24(2.1%,p<.0001)andmonth36(2.4%,p<.0001).AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSMenaged≥70years(n=127)hadsignificantlygreaterchangesinLBMatallmeasuredtimepoints.At36months,LBMdecreasedby2.8%inmenaged≥70yearscomparedwithadecreaseof0.9%inyoungermen(p=0.035).AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONThisisthelargestandlongestprospectivestudyundertakentodescribethenaturalhistoryofmusclelossinmenundergoingADTtherapyforprostatecancer.LBMsignificantlydecreasedat12,24,and36months.DecreasesinLBMweregreatestinoldermenandinthosewhohadshortdurationofADTatstudyentry.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAUA(2019)內(nèi)分泌治療新進(jìn)展RecoveryoftestosteroneandPSAaftercessationoflongtermluteinizinghormonereleasinghormoneagonist(LHRH)therapyforprostatecancer:aprospectivetrial.MatthewMcIntyre,Charleston,SCAUA(2019)內(nèi)分泌治療新進(jìn)展RecoveryoftAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESTheuseofhormonalmanipulationinthetreatmentofprostatecancerhasbeenanoptionsincethetimeofHugginsinitialdescription.However,manyquestionsremainregardingtimingofinitiation,andlengthoftreatmentintervalformedicallyinducedcastration.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESTheeffectsoflongtermLHRHagonistonthehypothymalicpituitarygonadalaxisarealsonotcompletelyunderstood.WesoughttoexaminetheeffectsoflongtermLHRHagonistonrecoveryoftestosteroneandPSA.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSHormonalablationwasdiscontinuedandserialtestosteroneandPSAmeasurementswereobtainedonathreemonthlybasis.Patientswerecounseledregardingrestartinghormonaltherapyif2consecutiverisesinPSAwereobserved.Patientswereallowedtostayoffhormonesandonstudyiftheydesired.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSWeorganizedaprospectivetrialexaminingmenattheVeteransAdministrationHospitalwhohadbeenonatleast48monthsofanLHRHagonist.OtherinclusioncriteriawerethatPSAbelessthan3ng/ml,andnotrisingforthe2consecutivevaluespriortodiscontinuinghormones.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSNineteenpatientswereenrolledinthestudybetween2019and2019.Themeanagewas75years.

Themeandurationofhormonaltherapywas88months.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSTen(53%)patientswereonhormonesforbiochemicalrecurrence；Two(10%)formetastaticdisease；Seven(36%)asprimarytherapy.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSEleven(58%)patientshad2consecutiverisesinPSA;Themeantimetoseetwoconsecutiveriseswas11months.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSThemeantimeofftherapypriortoariseinPSA0.1ng/mlabovebaselineforallpatientsandthosewith2consecutiveriseswas15.4and9.5monthsrespectively.ThemeanbaselinePSA,meanPSAatone,andattwoyearsofftherapywas0.3ng/ml,1.1ng/ml,and5ng/mlrespectively.Meantestosteroneatbaseline,one,andtwoyearsofftherapywas13.9ng/ml,76ng/ml,and150.6ng/mlrespectively.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSTwelve(63%)patientshadrecoveryoftestosteroneabove50ng/dl.Four(21%)patientsremainedcastrateofftherapyameanof20months.Themeantimetotestosteronerecoverywas12.8months.Two(10.5%)patientsinthestudyhavedied.Onedeathwasattributedtoprostatecancer.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONTherecoveryoftestosteroneandsignificantelevationsofPSAafterlongtermLHRHagonisttherapyissignificantlydelayedinmostpatients.Thishelpstosupporttheconceptofintermittentandrogenablationwhichhasbenefitsinqualityoflifeandreducedcostoftherapy.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONDataonfile手術(shù)去勢(shì)的副作用增加心血管疾病和糖尿病發(fā)病率Dataonfile手術(shù)去勢(shì)的副作用Dataonfile手術(shù)去勢(shì)的副作用增加骨折發(fā)病率Dataonfile手術(shù)去勢(shì)的副作用抑那通通過抑制雄性激素的作用而抑制大白鼠前列腺腫瘤的增殖

醋酸亮丙瑞林水溶液0.333mg/kg/日（1日1次投藥)醋酸亮丙瑞林水溶液0.333mg/kg/日（1日2次投藥)抑那通相當(dāng)于0.333mg/kg/日（1月1次投藥)閹割腫瘤移植后的天數(shù)腫瘤體積(cm)對(duì)照醋酸亮丙瑞林水溶液1mg/kg/日（1日1次投藥)抑那通與睪丸切除術(shù)抗腫瘤作用比較抑那通通過抑制雄性激素的作用而抑制大白鼠前列腺腫瘤的增殖抑那通治療前列腺癌的綜合效果抑那通治療前列腺癌的綜合效果抑那通治療前列腺癌各病灶的療效抑那通治療前列腺癌各病灶的療效抑那通改善前列腺癌各種癥狀的效果明顯抑那通改善前列腺癌各種癥狀的效果明顯抑那通治療前列腺癌從起效到部分緩解的時(shí)間抑那通治療前列腺癌從起效到部分緩解的時(shí)間

間歇療法與持續(xù)療法患者生存率相當(dāng)Dataonfile間歇療法與持續(xù)療法患者生存率相當(dāng)Dataonfile抑那通間歇療法顯著降低前列腺體積第1周期第2周期前列腺體積變化比例(%)BruchovskyN,etal.Cancer.2019Jul15;107(2):389-95抑那通間歇療法顯著降低前列腺體積第1周期第2周期前列腺體積變抑那通間歇療法迅速降低PSA值到達(dá)PSA最低值所需時(shí)間(月)HiganoCS,etal.Urology.2019Nov;48(5):800-4抑那通間歇療法迅速降低PSA值到達(dá)PSA最低值所需時(shí)間(月)間歇療法減少骨質(zhì)丟失，降低副反應(yīng)發(fā)生率UifTunn2019BjuInternational99,supplement1,19-22間歇療法減少骨質(zhì)丟失，降低副反應(yīng)發(fā)生率UifTunn20Dataonfile間歇期雄激素明顯恢復(fù)，可改善患者生活質(zhì)量Dataonfile間歇期雄激素明顯恢復(fù)，可改善患者生活間歇療法有利于患者性功能恢復(fù)N.A.Spry,etalEuropeanJournalofCancer42(2019):1083-1092間歇療法有利于患者性功能恢復(fù)N.A.Spry,etalE間歇期暫停用藥，大幅度降低治療成本間歇期暫停用藥，大幅度降低治療成本總結(jié)

有效治療前列腺癌患者生存率與持續(xù)療法相當(dāng)與去勢(shì)療法相比，副作用顯著降低改善性功能，提高生活質(zhì)量降低治療成本抑那通間歇療法優(yōu)勢(shì)突出總結(jié)有效治療前列腺癌抑那通間歇療法優(yōu)勢(shì)突出抑那通3.75mg預(yù)充式注射器現(xiàn)有劑型上市新劑型抑那通3.75mg預(yù)充式注射器現(xiàn)有劑型上市新劑型抑那通治療前列腺癌的新進(jìn)展抑那通治療前列腺癌的新進(jìn)展AUA(2019)內(nèi)分泌治療新進(jìn)展Radiotherapycombinedwithandrogendeprivationvs.androgendeprivationaloneinclinicallylocallyadvancedprostatecanerinamulticenterrandomisedphaseIIIstudyNicolasMottet,France.AUA(2019)內(nèi)分泌治療新進(jìn)展RadiotherapyAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESInlocallyadvanceddisease,thecombinationofradiotherapy(RT)andandrogendeprivation(ADT)issuperiortoRTalone.ButADTwithananaloguehasneverbeencomparedtocombinedmodality.WereportaphaseIIIrandomisedtrialinlocallyadvancedPCa,comparingacombinedmodalityandADTonly.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSInthisFrenchmulticenter,open,randomisedtrial,patientslessthan80years,withhistologicallyconfirmedPCa,T3-4,orpT3(biopsy)N0M0wereincluded.Theywerecentrallyrandomisedin2parallelgroupstoeitherADTalone(leuprorelin11.25mgSR,1scinjectionevery3monthsfor3yearsorthesameADTcombinedwithRTstartingwithin3monthsover7weeks.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSHTHT+RTPN131133MeanAge70.570.70.63MeanPSAbaseline51.7741.500.79MedianPFS(days)126425440.0005PFS(5year)(%)15.464.70.0005Biologicalprogression(%)71.519.5<0.0001Clinicalprogression(%)37.711.3<0.0001AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSHTHT+RAUA(2019)內(nèi)分泌治療新進(jìn)展Prevalenceofmetabolicsyndromeinprostatecancerpatientsunderandrogendeprivationtherapy:interimresultsofacase-controlstudy.JorgeRopero,Barcelone,Spain.AUA(2019)內(nèi)分泌治療新進(jìn)展PrevalenceofAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESCardiovascularmortalityisthemostimportantcauseofdeathinpatientswithprostatecancer(PC).Thedevelopmentofmetabolicsyndrome(MS)inpatientsundergoingandrogendeprivationtherapy(ADT)hasbeenrelatedwiththisincreaseinmortalityrate.TheaimofthisstudyhasbeentoconfirmthehypothesisthatADTincreasestheprevalenceofMS.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAgroupof157patientswereenrolledinthisinterimanalysisofaprospectivecasecontrolstudy.53PCpatientsunderADTduringameantimeof52months(6to252)and104agematchedcontrolsevaluatedatthetimeofprostatebiopsy(52withcancerand52without)wereincluded.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSMSwasanalyzedaccordingtheATPIIIpanelcriteria:Fastingplasmaglucoselevel>110mg/dLserumtriglyceridelevel>150mg/dLserumhigh-densitylipoproteinlevel<40mg/dLwaistcircumference>102cmBloodpressureof>130/85mmHg.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSMSwasdiagnosedin27ofthe53patientssubjectedtoADT(51.9%)whileitwasdetectedin35ofthe105age-matchedcontrols(33.3%),p=0.020.HowevertheprevalenceofMSwas35.8%(19/53)inmenwithoutPCand30.8%(16/52)inmenwithPC,p=0.365.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAlthoughthelimitednumbercasesandcontrolsincludedinthisinterimanalysis,asignificantincreaseintheprevalenceofMSwasobservedinPCpatientssubjectedtoADT.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAUA(2019)內(nèi)分泌治療新進(jìn)展MetabolicchangeafterandrogendeprivationtherapyinKoreanmenwithprostatecancerChangHooPark,KoreaAUA(2019)內(nèi)分泌治療新進(jìn)展MetabolicchaAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESInmenwithprostatecancer,Androgendeprivationtherapyshowsavarietywellrecognizedmetabolicalteration.TobettercharacterizethemetaboliceffectsofandrogendeprivationtherapyinKoreanmen,weevaluatedthechangesinfatthickness,bonemineraldensity(BMD),bodymassindex(BMI),andlevelsofhemoglobin(Hb)andcholesterol.Wealsocomparedthemwithdatafromhealthysubjects.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSFromDecember2019toDecember2019,148Koreanmentreatedwithleuprolidedepotandbicalutamideforprostatecancerand100healthysubjectswereinvestigatedincludedchangefrombaselinetomonth12infatthickness,bonemineraldensity(BMD),bodymassindex(BMI),andlevelsofhemoglobin(Hb)andcholesterol.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSADTControlPN148100Fatthickness(mm)20.416.9<0.05BMD=bonemineraldensity0.910.94<0.05BMI(kg/m2)23.922.9<0.05Therearenosignificantchangesinhemoglobinandcholesterollevels.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSADTConAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONOurresultsshowthatKoreanmenwithprostatecancerhaveincreasedabdominalsubcutaneousfatandBMIandhavedecreasedBMDduringandrogendeprivationtherapy.Theseincreasestheriskofbonefractureandcomplicationrelatedobesity.Therefore,BMDwillbecheckedperiodicallyandcarryoutexerciseprogramtopreventionobesityduringandrogendeprivationtherapy.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAUA(2019)內(nèi)分泌治療新進(jìn)展Sarcopeniainmenreceivingandrogendeprivationtherapyforprostatecancer:aprospective3-yearstudy.MatthewR.Smith,CA.AUA(2019)內(nèi)分泌治療新進(jìn)展SarcopeniainAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESAndrogendeprivationtherapy(ADT)forprostatecancerdecreasesbonemineraldensityandincreasesfracturerisk.StudieswithlimitedsamplesizeandobservationalperiodshavereportedthatADTisalsoassociatedwithsarcopeniaorlossofmuscle(leanbodymass,LBM).WenowreporttheprospectivechangesinLBMinasubsetofmenfromthatstudy.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSMenundergoingADTfornonmetastaticprostatecancerat38centersinNorthAmericawererandomizedtodenosumaborplacebo.Atotalof248subjects(130denosumab,118placebo)withabaselineandwithatleast1on-studyLBMresultwereconsideredevaluableandincludedinthisanalysis.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSSubjectswerestratifiedatbaselinebyage(<70yearsvs≥70years)andbydurationofADTtreatment(≤6monthsvs>6months).LBMwasmeasuredbytotalbodydual-energyx-rayabsorptiometryatbaselineandat12,24,and36months.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSFrombaselinetomonth12,meanLBMdecreasedsignificantlyby1.0%(p=.0004).SignificantdecreasesinLBMwerealsoobservedatmonth24(2.1%,p<.0001)andmonth36(2.4%,p<.0001).AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSMenaged≥70years(n=127)hadsignificantlygreaterchangesinLBMatallmeasuredtimepoints.At36months,LBMdecreasedby2.8%inmenaged≥70yearscomparedwithadecreaseof0.9%inyoungermen(p=0.035).AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONThisisthelargestandlongestprospectivestudyundertakentodescribethenaturalhistoryofmusclelossinmenundergoingADTtherapyforprostatecancer.LBMsignificantlydecreasedat12,24,and36months.DecreasesinLBMweregreatestinoldermenandinthosewhohadshortdurationofADTatstudyentry.AUA(2019)內(nèi)分泌治療新進(jìn)展CONCLUSIONAUA(2019)內(nèi)分泌治療新進(jìn)展RecoveryoftestosteroneandPSAaftercessationoflongtermluteinizinghormonereleasinghormoneagonist(LHRH)therapyforprostatecancer:aprospectivetrial.MatthewMcIntyre,Charleston,SCAUA(2019)內(nèi)分泌治療新進(jìn)展RecoveryoftAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESTheuseofhormonalmanipulationinthetreatmentofprostatecancerhasbeenanoptionsincethetimeofHugginsinitialdescription.However,manyquestionsremainregardingtimingofinitiation,andlengthoftreatmentintervalformedicallyinducedcastration.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONANDOBJECTIVESTheeffectsoflongtermLHRHagonistonthehypothymalicpituitarygonadalaxisarealsonotcompletelyunderstood.WesoughttoexaminetheeffectsoflongtermLHRHagonistonrecoveryoftestosteroneandPSA.AUA(2019)內(nèi)分泌治療新進(jìn)展INTRODUCTIONAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSHormonalablationwasdiscontinuedandserialtestosteroneandPSAmeasurementswereobtainedonathreemonthlybasis.Patientswerecounseledregardingrestartinghormonaltherapyif2consecutiverisesinPSAwereobserved.Patientswereallowedtostayoffhormonesandonstudyiftheydesired.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展METHODSWeorganizedaprospectivetrialexaminingmenattheVeteransAdministrationHospitalwhohadbeenonatleast48monthsofanLHRHagonist.OtherinclusioncriteriawerethatPSAbelessthan3ng/ml,andnotrisingforthe2consecutivevaluespriortodiscontinuinghormones.AUA(2019)內(nèi)分泌治療新進(jìn)展METHODSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSNineteenpatientswereenrolledinthestudybetween2019and2019.Themeanagewas75years.

Themeandurationofhormonaltherapywas88months.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSTen(53%)patientswereonhormonesforbiochemicalrecurrence；Two(10%)formetastaticdisease；Seven(36%)asprimarytherapy.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSEleven(58%)patientshad2consecutiverisesinPSA;Themeantimetoseetwoconsecutiveriseswas11months.AUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSAUA(2019)內(nèi)分泌治療新進(jìn)展RESULTSThemeantimeofftherapypriortoariseinPSA0.1ng/mlabovebaselineforallpatientsandthosewith2consecutiveriseswas15.4and9.5