前列腺癌内分泌治疗现状

前列腺癌（prostatecancerPC）是欧美国家男性发病率最高的恶性肿瘤,近年来其在我国的发病率也逐年升高。雄激素在PC的发生、发展过程中扮演着重要的角色,所以内分泌治疗一直是前列腺癌研究领域的重点,但是其可能诱发激素非依赖型PC这也是临床医学面临的一大问题。本文就前列腺癌内分泌治疗的分类、作用机制、用药策略及临床效果等作一综述。     

嵌合分子(DHT-PROTAC)在前列腺癌研究中的进展

前列腺癌多发于老年男性,已成为老年男性常见肿瘤之一。内分泌治疗目前是晚期前列腺癌主要治疗方法,但仍避免不了前列腺癌最终进展成激素非依赖性前列腺癌,导致内分泌治疗的失败。当前,对前列腺癌细胞株的AR表达的研究,主要集中在DNA水平及mRNA水平,而对AR蛋白翻译后调控的研究较少。近些年来,嵌合分子(DHT-PROTAC)是基于蛋白水平,调控AR蛋白的表达,成为研究前列腺癌转归新的热点。DHT-PROTAC是一种新型人工合成的异型双功能小分子;这种小分子是DHT与泛素连接酶E3识别基团的嵌合体,它不仅能与AR结合,而且能在结合后,诱导AR的泛素化,从而通过泛素-蛋白酶途径降解AR;本文介绍了嵌合分子的作用原理,回顾了近些年前列腺癌的治疗进展,分析了嵌合分子将来在前列腺癌治疗中的应用前景。     

嵌合分子（DHT-PROTAC）在前列腺癌研究中的进展

前列腺癌多发于老年男性,已成为老年男性常见肿瘤之一。内分泌治疗目前是晚期前列腺癌主要治疗方法,但仍避免不了前列腺癌最终进展成激素非依赖性前列腺癌,导致内分泌治疗的失败。当前,对前列腺癌细胞株的AR表达的研究,主要集中在DNA水平及mRNA水平,而对AR蛋白翻译后调控的研究较少。近些年来,嵌合分子（DHT-PROTAC）是基于蛋白水平．调控AR蛋白的表达,成为研究前列腺癌转归新的热点。DHT-PROTAC是一种新型人工合成的异型双功能小分子;这种小分子是DHT与泛素连接酶E3识别基团的嵌合体,它不仅能与AR结合,而且能在结合后,诱导AR的泛素化,从而通过泛素一蛋白酶途径降解AR;本文介绍了嵌合分子的作用原理,回顾了近些年前列腺癌的治疗进展,分析了嵌合分子将来在前列腺癌治疗中的应用前景。     

长非编码RNA 的表达与前列腺癌的研究进展

前列腺癌是全球发病率第二的男性恶性肿瘤,近年来我国前列腺癌的发病率显著上升。最近,大量研究发现,长非编码RNA表达水平的改变与前列腺癌的发生、发展、诊断、治疗和预后密切相关。该文就长非编码RNA与前列腺癌的关系及相关机理进行综述,有助于读者了解长非编码RNA在前列腺癌发病过程中的重要性,为前列腺癌的综合防治提供线索。     

前列腺癌的早期信号——IGF-I

前列腺癌是男性易发的疾病,在欧美发病率极高,在高龄男性中仅次于肺癌。我国前列腺癌发病率在逐渐增加。人前列腺特异性抗原（ＰＳＡ）是前列腺上皮分泌的一种糖蛋白。前列腺癌发生时会释放大量ＰＳＡ进入血液,因此测定血清ＰＳＡ在前列腺癌的诊断和治疗后追踪方面有重...     

敲减BLM解旋酶表达增强前列腺癌PC3细胞对丝裂霉素C的敏感性

丝裂霉素C是一种广谱抗肿瘤抗生素,对多种癌症有抗癌作用,其作用原理可使细胞的DNA发生链间交联,引起DNA双链断裂,阻碍DNA的复制,从而抑制肿瘤细胞分裂。临床上主要用于胃癌、肠癌、肝癌及胰腺癌等消化道癌方面的治疗。本文研究丝裂霉素C对转染人BLM解旋酶基因（shRNA载体）前后前列腺癌PC3细胞活性的影响。使用前期成功构建的干扰载体转染PC3细胞,在转染48 h后加药,通过荧光定量PCR、MTT法、Transwell小室实验、细胞划痕实验、流式细胞术,分别检测加药12、24、36 h BLM基因的表达量、PC3细胞增殖能力、侵袭能力、迁移能力及凋亡情况的变化。结果显示,敲减BLM基因表达后的PC3细胞相对于正常PC3细胞其增殖能力、侵袭能力和迁移能力能显著被丝裂霉素C抑制,且丝裂霉素C能显著促进其细胞的凋亡,说明BLM基因低表达的前列腺癌细胞对丝裂霉素C更敏感。研究结果为丝裂霉素C在前列腺癌的临床治疗上奠定了理论基础。     

前列腺癌治疗靶点及相关药物药理药效学评估体系

前列腺癌一直是欧美男性高发疾病,在我国尤其是经济发达城市,近年来其发病率随着社会老年化进程加速而呈迅猛上升之势。据估,未来10 年,我国前列腺癌的发病或将进入高峰期,成为男性第1 大癌症杀手。目前前列腺癌尤其是晚期前列腺癌治疗药物的疗效有限且毒副作用较大,是困扰临床医生和患者的难题,故开发高效低毒的抗前列腺癌药物具有重要的现实意义。综述前列腺癌治疗靶点以及包含体内外模型和临床疗效评估指标的抗前列腺癌药物药理药效学评估体系,为前列腺癌治疗药物的研究与开发提供参考。     

CXC趋化因子与前列腺癌

前列腺癌是常见男性泌尿系恶性肿瘤,近年发病率呈明显增长趋势.其机制尚不清楚,大量研究表明CXC趋化因子及其受体在前列腺癌中具有多效性,CXC趋化因子由原发部或远端转移处的肿瘤细胞和基质微环境产生,并参与前列腺癌生长调节、血管生成、侵袭和转移.本文就CXC趋化因子及其受体与前列腺癌的关系作论述,为治疗前列腺癌提供依据.     

人前列腺癌雄激素受体的变异与临床

人前列腺癌雄激素受体的变异与临床王晓慧卢建（第二军医大学病理生理教研室,上海２００４３３）关键词前列腺癌雄激素受体内分泌治疗Ｆｌｕｔａｍｉｄｅ撤药综合征前列腺癌（ＰＣ）是老年男性的常见肿瘤,在美国是造成男性癌症死亡仅次于肺癌的第二位原因,在我国随着人...     

前列腺癌与表观遗传修饰

前列腺癌是威胁男性健康的主要恶性肿瘤之一,近年来其发病率呈上升趋势。前列腺癌的发生是遗传学因素和表观遗传因素共同作用的结果。本文简要综述了PcG(polycomb group)蛋白质、AR共调节子和微RNA(microRNA)等表观遗传修饰方式与前列腺癌的联系,希望有助于前列腺癌的诊断和治疗。     

Androgen receptor: a key molecule in the progression of prostate cancer to hormone independence

Despite earlier detection and recent advances in surgery and radiation, prostate cancer is second only to lung cancer in male cancer deaths in the United States. Hormone therapy in the form of medical or surgical castration remains the mainstay of systemic treatment in prostate cancer. Over the last 15 years with the clinical use of prostate specific antigen (PSA), there has been a shift to using hormone therapy earlier in the disease course and for longer duration. Despite initial favorable response to hormone therapy, over a period of time these tumors will develop androgen‐independence that results in death. The androgen receptor (AR) is central to the initiation and growth of prostate cancer and to its response to hormone therapy. Analyses have shown that AR continues to be expressed in androgen‐independent tumors and AR signaling remains intact as demonstrated by the expression of the AR regulated gene, PSA. Androgen‐independent prostate cancers have demonstrated a variety of AR alterations that are either not found in hormone naïve tumors or found at lower frequency. These changes include AR amplification, AR point mutation, and changes in expression of AR co‐regulatory proteins. These AR changes result in a “super AR” that can respond to lower concentrations of androgens or to a wider variety of agonistic ligands. There is also mounting evidence that AR can be activated in a ligand independent fashion by compounds such as growth factors or cytokines working independently or in combination. These growth factors working through receptor tyrosine kinase pathways may promote AR activation and growth in low androgen environments. The clinical significance of these AR alterations in the development and progression of androgen‐independent prostate cancer remains to be determined. Understanding the changes in AR signaling in the evolution of androgen‐independent prostate cancer will be key to the development of more effective hormone therapy. © 2003 Wiley‐Liss, Inc.     

Endocrine treatment of prostate cancer

Although androgen deprivation as a treatment for patients with prostate cancer was described more than 60 years ago its optimal use remains controversial. The widespread use of prostate-specific (PSA) assay has lead to earlier diagnosis and earlier detection of recurrent disease. This means that the systemic side effects of androgen deprivation and quality of life have become more important. Debates continue regarding the proper use and timing of endocrine therapy with orchiectomy, oestrogen agonists, gonadotropin hormone-releasing hormone (GnRH) agonists, GnRH antagonists, and androgen antagonists. A critical review of the literature was performed. Data support that androgen deprivation is an effective treatment for patients with advanced prostate cancer. However, although it improves survival, it is not curative, and creates a spectrum of unwanted effects that influence quality of life. Castration remains the frontline treatment for metastatic prostate cancer, where orchiectomy, oestrogen agonists and GnRH agonists produce equivalent clinical responses. Maximum androgen blockade (MAB) is not significantly more effective than single agent GnRH agonist or orchiectomy. Nonsteroidal antiandrogen monotherapy is as effective as castration in treatment of locally advanced prostate cancer offering quality of life benefits. Adjuvant endocrine treatment is able to delay disease progression at any stage. There is, however, controversy of the possible survival benefit of such treatment, including patients having PSA relapse after definitive local treatment for prostate cancer. Neoadjuvant endocrine treatment has its place mainly in the external beam radiotherapy setting. Intermittent androgen blockade is still considered experimental. The decision regarding the type of androgen deprivation should be made individually after informing the patient of all available treatment options, including watchful waiting, and on the basis of potential benefits and adverse effects. Several large studies are under way to investigate the role of adjuvant endocrine treatment in the field of early prostate cancer, intermittent androgen deprivation and endocrine therapy alone compared with endocrine therapy with radiotherapy. The real challenge, however, is to develop better means to avert hormone-refractory prostate cancer and better treatments for patients with hormone-refractory disease when it occurs.     

Combination therapy with flutamide and medical (LHRH agonist) or surgical castration in advanced prostate cancer: 7-year clinical experience

Three hundred and sixty-three patients with clinical stage D2 prostate cancer who had not received previous endocrine therapy or chemotherapy were treated with the combination therapy using the pure antiandrogen Flutamide and the LHRH agonist [ -Trp⁶,des-Gly-NH₂¹⁰]LHRH ethylamide (or orchiectomy) for an average of 771 days (24–2607 days). Only 31 of the 308 evaluable patients (10.1%) did not show an objective positive response at the start of the combination therapy compared with an average of 18% in five recent studies using monotherapy. The median survival achieved using monotherapy is approximately 24 months while, in the present study, it is increased to 41.2 months, thus giving an additional 17 months of survival with the combination therapy. It should be mentioned that at the time of relapse, combination therapy is continued and, addition, further blockade of adrenal androgen secretion is achieved with aminoglutethimide and hydrocortisone. While our studies showing the advantages of combination therapy with pure antiandrogen in advanced prostate cancer have been confirmed by independent large-scale randomized studies, our preliminary data clearly suggest the interest of downstaging early stage prostate cancer by temporary combination therapy prior to radical prostatectomy.     

立体定向放疗联合内分泌治疗对转移性激素敏感性前列腺癌患者免疫功能和生活质量的影响

摘要 目的：探讨立体定向放疗（SBRT）联合内分泌治疗对转移性激素敏感性前列腺癌患者生活质量、免疫功能的影响。方法：选取我院2015年2月~2017年2月期间收治的转移性激素敏感性前列腺癌患者100例,根据信封抽签法将患者分为对照组（50例）和放疗组（50例）,对照组给予内分泌治疗,放疗组在对照组的基础上联合SBRT治疗。对比两组前列腺特异性抗原（PSA）进展时间、PSA缓解率、治疗期间不良反应状况、3年生存率、免疫功能（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）和扩展性前列腺癌复合指数量表（EPIC）各项评分。结果：随访3年,对照组有2例失访、放疗组有3例失访,放疗组的PSA进展时间长于对照组（P<0.05）,放疗组的3年生存率高于对照组（P<0.05）。治疗后,两组CD3⁺、CD4⁺/CD8⁺、CD4⁺均下降,但放疗组较对照组升高（P<0.05）,两组治疗后CD8⁺均升高,但放疗组较对照组降低（P<0.05）。治疗后6个月,放疗组性功能、激素功能、泌尿功能、肠道功能领域评分均高于对照组（P<0.05）。两组不良反应总发生率、PSA缓解率组间对比无差异（P>0.05）。结论：SBRT联合内分泌治疗转移性激素敏感性前列腺癌患者,可延长患者PSA进展时间,减轻免疫抑制,提高患者生活质量,同时还可改善患者的预后,患者耐受性良好。     

A polysaccharide from Dictyophora indusiata inhibits the immunosuppressive function of cancer‐associated fibroblasts

Reversing the function of cancer‐associated fibroblasts (CAFs) may improve the efficacy of cancer therapy. Here, we isolated a novel polysaccharide from Dictyophora indusiata (ZSP4) and examined its effects on the function of prostate CAFs. The supernatant of prostate CAFs can stimulate the proliferation of immune cells and inhibit the growth of CD4+/CD8+ T cells. However, after ZSP4 stimulation, the functions of prostate CAFs were inhibited. The mechanism experiment shows that ZSP4 can stimulate prostate CAFs by down‐regulating the expression of α‐smooth muscle actin. Polysaccharides extracted from Dictyophora indusiata stimulate the proliferation of immune cells and reverse the immune‐suppressive functions of prostate CAFs, shedding new light on the development of novel anticancer strategies. The endocrine therapy used to treat prostate cancer aims to eliminate androgenic activity from prostatic tissue; these therapies are painful and of poor therapeutic effect. In this study, we found that polysaccharides extracted from Dictyophora indusiata may affect the micro‐environment of tumours and inhibit the growth of the tumours. Our results suggest that polysaccharides may modulate negative immune regulation and enhance antitumour immunity, which is important for clinical therapy.     

Prostate cancer gene therapy-what have we learned and where are we going?

With recent advances in genetic engineering, tumor biology, and immunology, gene therapy has been recognized as a promising new treatment option for various cancers, including prostate cancer. Several clinical trials of prostate cancer gene therapy, using therapeutic genes which include suicide genes, immunomodulatory genes, tumor suppressor genes, and anti-oncogenes, are under way and preliminary reports have emerged. Although gene therapy for prostate cancer is still at an early stage and requires additional technological breakthroughs, new insights obtained from recent clinical trials indicate a promising potential for prostate cancer gene therapy. In this report, general concepts, current progress, and future prospects in prostate cancer gene therapy are summarized.     

Androgen axis in prostate cancer

Endocrine therapy for advanced prostate cancer is based on androgen ablation or blockade of the androgen receptor (AR). AR action in prostate cancer has been investigated in a number of cell lines, their derivatives, and transgenic animals. AR expression is heterogenous in prostate cancer in vivo; it could be detected in most primary tumors and their metastases. However, some cells lack the AR because of epigenetic changes in the gene promoter. AR expression increases after chronic androgen ablation in vitro. In several xenografts, AR upregulation is the most consistent change identified during progression towards therapy resistance. In contrast, the AR pathway may be by-passed during chronic treatment with a nonsteroidal anti-androgen. AR sensitivity in prostate cancer increases as a result of activation of the Ras/mitogen-activated protein kinase pathway. One of the major difficulties in endocrine therapy for prostate cancer is acquisition of agonistic properties of AR antagonists observed in the presence of mutated AR. Enhancement of AR function by associated coactivator proteins has been extensively investigated. Cofactors SRC-1, RAC3, p300/CBP, TIF-2, and Tip60 are upregulated in advanced prostate cancer. Most studies on ligand-independent activation of the AR are focused on Her-2/neu and interleukin-6 (IL-6). On the basis of studies that showed overexpression and activation of the AR in advanced prostate cancer, it was suggested that novel therapies that reduce AR expression will provide a benefit to patients. There is experimental evidence showing that prostate tumor growth in vitro and in vivo is inhibited following administration of chemopreventive drugs or antisense oligonucleotides that downregulate AR mRNA and protein expression.