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抑那通治疗前列腺癌的新进展北京大学第三医院黄毅AUA(2010)内分泌治疗新进展•Radiotherapycombinedwithandrogendeprivationvs.androgendeprivationaloneinclinicallylocallyadvancedprostatecanerinamulticenterrandomisedphaseIIIstudy•NicolasMottet,France.AUA(2010)内分泌治疗新进展INTRODUCTIONANDOBJECTIVES•Inlocallyadvanceddisease,thecombinationofradiotherapy(RT)andandrogendeprivation(ADT)issuperiortoRTalone.•ButADTwithananaloguehasneverbeencomparedtocombinedmodality.•WereportaphaseIIIrandomisedtrialinlocallyadvancedPCa,comparingacombinedmodalityandADTonly.AUA(2010)内分泌治疗新进展METHODS•InthisFrenchmulticenter,open,randomisedtrial,patientslessthan80years,withhistologicallyconfirmedPCa,T3-4,orpT3(biopsy)N0M0wereincluded.•Theywerecentrallyrandomisedin2parallelgroupstoeitherADTalone(leuprorelin11.25mgSR,1scinjectionevery3monthsfor3yearsorthesameADTcombinedwithRTstartingwithin3monthsover7weeks.AUA(2010)内分泌治疗新进展RESULTSHTHT+RTPN131133MeanAge70.570.70.63MeanPSAbaseline51.7741.500.79MedianPFS(days)126425440.0005PFS(5year)(%)15.464.70.0005Biologicalprogression(%)71.519.50.0001Clinicalprogression(%)37.711.30.0001AUA(2010)内分泌治疗新进展•Prevalenceofmetabolicsyndromeinprostatecancerpatientsunderandrogendeprivationtherapy:interimresultsofacase-controlstudy.•JorgeRopero,Barcelone,Spain.AUA(2010)内分泌治疗新进展INTRODUCTIONANDOBJECTIVES•Cardiovascularmortalityisthemostimportantcauseofdeathinpatientswithprostatecancer(PC).•Thedevelopmentofmetabolicsyndrome(MS)inpatientsundergoingandrogendeprivationtherapy(ADT)hasbeenrelatedwiththisincreaseinmortalityrate.•TheaimofthisstudyhasbeentoconfirmthehypothesisthatADTincreasestheprevalenceofMS.AUA(2010)内分泌治疗新进展METHODS•Agroupof157patientswereenrolledinthisinterimanalysisofaprospectivecasecontrolstudy.•53PCpatientsunderADTduringameantimeof52months(6to252)and104agematchedcontrolsevaluatedatthetimeofprostatebiopsy(52withcancerand52without)wereincluded.AUA(2010)内分泌治疗新进展METHODS•MSwasanalyzedaccordingtheATPIIIpanelcriteria:•Fastingplasmaglucoselevel110mg/dL•serumtriglyceridelevel150mg/dL•serumhigh-densitylipoproteinlevel40mg/dL•waistcircumference102cm•Bloodpressureof130/85mmHg.AUA(2010)内分泌治疗新进展RESULTS•MSwasdiagnosedin27ofthe53patientssubjectedtoADT(51.9%)whileitwasdetectedin35ofthe105age-matchedcontrols(33.3%),p=0.020.•HowevertheprevalenceofMSwas35.8%(19/53)inmenwithoutPCand30.8%(16/52)inmenwithPC,p=0.365.AUA(2010)内分泌治疗新进展CONCLUSION•Althoughthelimitednumbercasesandcontrolsincludedinthisinterimanalysis,asignificantincreaseintheprevalenceofMSwasobservedinPCpatientssubjectedtoADT.AUA(2010)内分泌治疗新进展•MetabolicchangeafterandrogendeprivationtherapyinKoreanmenwithprostatecancer•ChangHooPark,KoreaAUA(2010)内分泌治疗新进展INTRODUCTIONANDOBJECTIVES•Inmenwithprostatecancer,Androgendeprivationtherapyshowsavarietywellrecognizedmetabolicalteration.•TobettercharacterizethemetaboliceffectsofandrogendeprivationtherapyinKoreanmen,weevaluatedthechangesinfatthickness,bonemineraldensity(BMD),bodymassindex(BMI),andlevelsofhemoglobin(Hb)andcholesterol.•Wealsocomparedthemwithdatafromhealthysubjects.AUA(2010)内分泌治疗新进展METHODS•FromDecember2002toDecember2008,148Koreanmentreatedwithleuprolidedepotandbicalutamideforprostatecancerand100healthysubjectswereinvestigatedincludedchangefrombaselinetomonth12infatthickness,bonemineraldensity(BMD),bodymassindex(BMI),andlevelsofhemoglobin(Hb)andcholesterol.AUA(2010)内分泌治疗新进展RESULTSADTControlPN148100Fatthickness(mm)20.416.90.05BMD=bonemineraldensity0.910.940.05BMI(kg/m2)23.922.90.05Therearenosignificantchangesinhemoglobinandcholesterollevels.AUA(2010)内分泌治疗新进展CONCLUSION•OurresultsshowthatKoreanmenwithprostatecancerhaveincreasedabdominalsubcutaneousfatandBMIandhavedecreasedBMDduringandrogendeprivationtherapy.•Theseincreasestheriskofbonefractureandcomplicationrelatedobesity.Therefore,BMDwillbecheckedperiodicallyandcarryoutexerciseprogramtopreventionobesityduringandrogendeprivationtherapy.AUA(2010)内分泌治疗新进展•Sarcopeniainmenreceivingandrogendeprivationtherapyforprostatecancer:aprospective3-yearstudy.•MatthewR.Smith,CA.AUA(2010)内分泌治疗新进展INTRODUCTIONANDOBJECTIVES•Androgendeprivationtherapy(ADT)forprostatecancerdecreasesbonemineraldensityandincreasesfracturerisk.•StudieswithlimitedsamplesizeandobservationalperiodshavereportedthatADTisalsoassociatedwithsarcopeniaorlossofmuscle(leanbodymass,LBM).•WenowreporttheprospectivechangesinLBMinasubsetofmenfromthatstudy.AUA(2010)内分泌治疗新进展METHODS•MenundergoingADTfornonmetastaticprostatecancerat38centersinNorthAmericawererandomizedtodenosumaborplacebo.•Atotalof248subjects(130denosumab,118placebo)withabaselineandwithatleast1on-studyLBMresultwereconsideredevaluableandincludedinthisanalysis.AUA(2010)内分泌治疗新进展METHODS•Subjectswerestratifiedatbaselinebyage(70yearsvs≥70years)andbydurationofADTtreatment(≤6monthsvs6months).•LBMwasmeasuredbytotalbodydual-energyx-rayabsorptiometryatbaselineandat12,24,and36months.AUA(2010)内分泌治疗新进展RESULTS•Frombaselinetomonth12,meanLBMdecreasedsignificantlyby1.0%(p=.0004).•SignificantdecreasesinLBMwerealsoobservedatmonth24(2.1%,p.0001)andmonth36(2.4%,p.0001).AUA(2010)内分泌治疗新进展RESULTS•Menaged≥70years(n=127)hads