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首页> 外文期刊>The journal of sexual medicine >Re: Androgen Deprivation Therapy: Impact on Quality of Life and Cardiovascular Health
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Re: Androgen Deprivation Therapy: Impact on Quality of Life and Cardiovascular Health

机译：回复：雄激素剥夺疗法：对生活质量和心血管健康的影响

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The recent comprehensive review by Trost et al. highlighting the impact of androgen deprivation therapy (ADT) with luteinising hormone-releasing hormone agonists (LHRHa) on quality of life (QoL) of prostate cancer survivors is timely in view of increasing usage and accumulating evidence of its harms [1]. LHRHa were developed because oral estrogen, a major option for treating prostate cancer through ADT in the second half of the 20th century, was discontinued due to its excessive cardiovascular (CVS) mortality [2]. The authors report a wide range of adverse events with LHRHa and include advice for monitoring and management options [1]. That contemporary ADT using LHRHa suppresses endogenous testosterone levels (by about 95%) is well known but that estrogen is derived from testosterone via aromatization and endogenous estrogen levels are consequently also reduced (by about 80%) is far less appreciated [3,4]. Thus in addition to achieving the treatment objective of arresting prostate tumor growth, the castrated male suffers unwanted side effects from this iatrogenic hypogonadism including sarcopenia, anemia, and erectile dysfunction (testosterone lack) and osteoporosis (with high risk of fractures), hot flushes and probably, cognitive impairment (estrogen lack) [5]. We concur that definitive evidence for the impact of castration on CVS mobidity/mortality remains wanting, but several observational studies support an increased risk of CVS complications [1,6].
机译：Trost等人最近的综合评论。鉴于增加用法并积累其危害的证据，强调黄体生成素释放激素激动剂（LHRHa）对雄激素剥夺疗法（ADT）对前列腺癌幸存者生活质量（QoL）的影响是及时的。之所以开发LHRHa是因为口服雌激素是20世纪下半叶通过ADT治疗前列腺癌的主要选择，但由于其过度的心血管（CVS）死亡率而被中止了[2]。作者报告了LHRHa的一系列不良事件，并包括监测和管理选择的建议[1]。使用LHRHa抑制当代ADT抑制内源性睾丸激素水平（约95％）是众所周知的，但是雌激素是通过芳香化作用从睾丸激素衍生而来的，因此内源性雌激素水平也降低了（约80％）[3,4]。 。因此，除了达到阻止前列腺肿瘤生长的治疗目的之外，cast割的男性还因这种医源性性腺功能减退症而遭受了不良副作用，包括肌肉减少症，贫血和勃起功能障碍（睾丸激素缺乏）和骨质疏松症（高骨折风险），潮热和可能是认知障碍（缺乏雌激素）[5]。我们一致认为，仍然需要关于去势对CVS发病率/死亡率的影响的确切证据，但是一些观察性研究支持CVS并发症风险增加[1,6]。

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