Résumé
Luteinizing hormone杛eleasing hormone agonist (LHRH?A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate?specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long?term follow?up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single?step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH?A in patients with preexisting CVD. There is considerable long?term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long?term follow?up.
Résumé
Objective To evaluate the use of LHRH A for treating prostatic cancer with the occurrence of metastasis or recurrence after castration. Methods LHRH A has been instituted to 9 cases of pathologically verified prostatic cancer with the occurrence of metastasis or recurrence after castration.The therapeutic results were studied. Results Ideal improvement was noted in 4 with all the parameters turned normal.These 4 patients have survived well for 7,3,2 and 1 year respectively.Marked improvement occurred in 2 with part of the parameters turned normal or markedly improved shortly after the treatment.The condition of 1 patient became stable with drop of blood PSA and shrinkage of the prostatic mass.In 3 patients,the metastatic lesion became stable.with the use of LHRH A,the penis became markedly atrophic. Conclusions LHRH A is markedly effective in most cases of prostatic cancer with the occurrence of metastasis or recurrence after castration.The therapeutic efficacy depends on the sensitivity of the prostate cancer cells to the drug.Drug resistance may issue as time goes by.
Résumé
The specific anti-rat LH in the peroxidase anti-peroxidase (PAP) immunohistochemical method was used to demonstrate the pituitary gonadotropic cells in the pregnant rats, and then the morphometric analysis method was used to study the change of the number, size and nucleo-cytoplasmic ratio parameters of the gonadotropic cells in pregnant rats after being injected by a high dose of LHRH-A.It was observed that on 24h after injection the number of gonadotropic cells decreased, their size became smaller and their nucleo-cytoplasmic ratio larger: the cell number per mm~3 pituitary tissue was from (4.25?0.21)?10~4 to (2.49?0.14)?10~4; the cell size from 1295?35?m~3 to 895?31?m~3; the nucleo-cytoplasmic ratio from 0.144?0.005 to 0.229?0.010. On 48h after injection these changes were in the process of recovery. On 168h after injection all parameters were recovered.Our observations suggest that after being injected by a high dose of LHRH-A the change of gonadotropic cells in pregnant rats results from the exogenous high dose of LHRH-A which has stimulated gonadotropic cells to release a great amount of LH. It is believed, however, that the changes of gonadotropic cells caused by a high dose of LHRH-A can still return to normal.