转移性激素敏感前列腺癌患者口服阿帕他胺3 d预防GnRH激动剂点火效应4例报告  

Report of 3-day application of apalutamide in prevention of flare-up effect of GnRH agonist in 4 cases with mHSPC

作　　者：刘正浩 杨春光 胡志全[1] 曾星 肖建华[2] LIU Zhenghao;YANG Chunguang;HU Zhiquan;ZENG Xing;XIAO Jianhua(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China;Department of Urology,First Clinical Medical College of China Three Gorges University)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]三峡大学第一临床医学院泌尿外科

出　　处：《临床泌尿外科杂志》2022年第10期743-748,共6页Journal of Clinical Urology

摘　　要：目的:探讨阿帕他胺单药应用于转移性激素敏感前列腺癌(mHSPC)对内分泌的影响和预防GnRH激动剂点火效应的效果。方法:第1例初诊mHSPC患者参考临床指南口服阿帕他胺2周后联用GnRH激动剂,口服阿帕他胺期间及雄激素剥夺治疗(ADT)前后均检测黄体生成素(LH)、睾酮、前列腺特异性抗原(PSA)。4例初诊mHSPC患者创新性应用阿帕他胺3 d后联用GnRH激动剂,ADT前后均检测LH、睾酮、PSA。以上5例患者监测排尿困难、骨痛等临床症状是否出现。结果:第1例患者单用阿帕他胺过程中LH与睾酮增加,PSA水平迅速下降;2周后加用GnRH激动剂,LH、睾酮及PSA稳定下降,展示了阿帕他胺强大的AR封闭能力。4例患者阿帕他胺单药治疗3 d后联合GnRH激动剂治疗,LH和睾酮先下降后上升,PSA持续下降。5例患者在ADT后均未出现排尿困难和骨痛增加。结论:单用阿帕他胺可引起LH及睾酮分泌增加,同时PSA水平稳定下降;阿帕他胺单药使用2周和3 d均可以有效预防GnRH激动剂注射后的点火效应,3 d方案可以使患者睾酮提前达到去势水平、简化治疗过程。Objective:To explore the effect of apalutamide monotherapy on the endocrine of metastatic hormone-sensitive prostate cancer(mHSPC)and the prevention of the flare-up effect of GnRH agonist.Methods:The first patient with newly diagnosed mHSPC followed the clinical guidelines for oral administration of apalutamide for 2 weeks and then combined with the GnRH agonist.Luteinizing hormone(LH),testosterone,PSA,dysuria,bone pain and other clinical symptoms were detected during the oral administration of apalutamide before and after androgen deprivation therapy(ADT).Four newly diagnosed mHSPC patients innovatively used apalutamide for 3 days and then combined with the GnRH agonist.LH,testosterone,PSA,dysuria,bone pain and other clinical symptoms were detected before and after ADT.Results:In the first patient,LH and testosterone increased during the process of apalutamide alone,and PSA level decreased rapidly.After 2 weeks of adding GnRH agonist,LH,testosterone and PSA decreased steadily,demonstrating the powerful AR closure ability of apalutamide.In the other patients,after combined treatment with GnRH agonist,LH and testosterone first decreased and then increased,while PSA continued to decrease.No patient experienced dysuria or increased bone pain after ADT.Conclusion:Apalutamide alone can increase the secretion of LH and testosterone,while PSA levels steadily decrease.Two-week and 3-day regimen of apalutamide alone can effectively prevent the flare-up effect after injection of GnRH agonist.The 3-day regimen can make the patient’s testosterone reach the castration level in advance and simplify the treatment process.

关 键 词：激素敏感前列腺癌 雄激素剥夺治疗 GNRH激动剂 点火效应 阿帕他胺 

分 类 号：R691.9[医药卫生—泌尿科学]