Shaplygin LV, PhD, E. Yu Smirnov, PhD
Main Military Clinical Hospital named.Burdenko, Moscow
Prostate cancer is among the most severe and common cancers.Among the causes of death from malignancy of prostate cancer in many countries, is the second-third places.In particular, in the United States, he is one of the most common forms of cancer in males: in 1996 the incidence was 317 thousand. New cases a year, the death rate - 41 400. The increase in morbidity and mortality observed in Russia as well.In 1989, the figure was 8.4 per 100 thousand. Population in 1996 had 11.3 .Thus, the growth rates for the period were equal to 34.5% and the mortality rate - 18.5%.
The etiology of this disease is not completely understood.However, most researchers have concluded that the occurrence of prostate cancer is caused by a violation of the regulation of the endocrine balance of hormones associated with changes in the hypothalamic-pituitary system at qualitative changes of hormone in the adrenal glands and te
In addition, among all the hormone-sensitive tumors Prostate cancer is the most sensitive to hormonal influences. 
is well known that the main goal of therapy for early forms of prostate cancer - a complete cure of the patient.Effective means of diagnosis in the early stages of the disease, allowing to identify 95% of tumors are screened with PSA determination of its level a year or two, with positive PSA data - transrectal ultrasound and digital rectal examination .However, according to the Cancer Research Center of RAMS , 60-80% of patients in the primary treatment already have metastases.
a long time a significant role played in terms of hormone synthetic estrogens (sinestrol, honvan, Fosfestrol).According to various authors, the overall five-year survival rate of patients who received estrogen treatment ranged from 18 to 22% .
However much pronounced side effects limit the use of this group of drugs: complications of the cardiovascular system, gastrointestinal tract, the blood coagulation system, immunosuppression.The severity of side effects is variable, possibly fatal.Therefore estrogen currently used mainly as a second-line treatment .
Another group of drugs that are widely used at present, are analogues of LH-releasing hormone (gozerilin, leuprorelin).
Being a synthetic analogue of the natural LH-RH, gozerilin inhibits pituitary release of LH, which leads to a decrease in the concentration of testosterone in the blood serum of men and estradiol concentrations in women.Moreover, this effect is reversible.In the initial stage of treatment gozerilin may cause a temporary increase in the concentration of testosterone in serum in men and estradiol - females.With prolonged use of isolation suppressed normal rhythm of LH-RH, as well as susceptibility to it receptor.The main side effect is a decrease in potency, which often requires the preparation.In addition, patients may experience increased blood pressure, arthralgia.At the beginning of therapy may increase bone pain.
essential role in modern schemes of hormone therapy for prostate cancer is given drugs with anti-androgen activity (antagonists of the androgen receptor).Currently distinguished with steroid androgens (cyproterone acetate, megestrol acetate), and nonsteroidal structure (flutamide, bicalutamide, nilutamide).Drugs with non-steroidal structure are more easily portable and fewer side effects.
flutamide is one of the most common and well-studied drug of this group.The mechanism of its action is due to competitive inhibition of testosterone and DTG binding to specific receptors, thus preventing the manifestation of their biological effects.Flutamide substantial positive effect is that the level of testosterone in the plasma was not reduced, and therefore, does not reduce potency observed even on prolonged application of the drug.On the other hand, sometimes a high level of testosterone can reduce the effect of the drug due to "unlock" receptors.Therefore flutamide often used in combination with gozerilinom or leuprolide.The advantage of the combination therapy was observed in four large, controlled trials.They showed that this combined treatment regimen increases as the lifespan in localized and distributed at stages of the disease .
In the first of these studies analyzed the effectiveness of preoperative combined hormone replacement therapy (a combination of flutamide and LH-RH agonist).The frequency forms resectable tumors increased from 50 to 78%.
However, even with antiandrogen monotherapy has a good therapeutic effect.According to the sources, the level of effectiveness of various drugs in this group when used in monotherapy as follows: partial tumor regression - 20-78% of patients, the stabilization process - 16-43%, the progression of the disease - 2-20%.When combined with anti-androgen medication and surgical castration partial regression was observed in 40-80% of patients, the stabilization process - at 16-53%, the progression - from 1-16% .
1. Matveev BP dissemenirovannogo Treatment of prostate cancer: experience in RAMS Cancer Research Center.Symposium "Modern approaches to treatment of diseases oncourological."Proc.Doc.1998.
2. Handbook of Oncology, ed.NN Trapeznikova and IV Poddubnaya.4th ed., 1996.
3. LaBrie F. Recent advances of hormone therapy for prostate cancer: the importance of early diagnosis and treatment.Symposium "Modern approaches to treatment of diseases oncourological."Proc.Doc.1998.
4. Kirby R. et al.Funasteride in assosiation with either flutamide or gozerilin as combination hormonal therapy in patients with stage M1 carcinoma of prostate gland // Prostate.1999, Jul.1: 4 (2);105-114.