根據(jù)2012年6月6日在線發(fā)表在Journal of Sexual Medicine期刊上的一篇論文，睪酮替代療法(testosterone replacement therapy, TRT)似乎是安全的,，并不增加前列腺癌發(fā)病率,。
英國倫敦大學(xué)學(xué)院醫(yī)院研究員Mark R. Feneley博士和倫敦男性健康中心研究員Malcolm Carruthers博士開展了一項(xiàng)最新的研究：分析接受TRT治療的男性的長期前列腺癌發(fā)病率。研究人員對患有雄激素缺乏癥并且正在接受TRT(顆粒植入,、十一烷酸睪酮,、美睪酮和Testogel)治療的1365名患者(平均年齡為55歲)的臨床數(shù)據(jù)進(jìn)行綜述，并且對這些臨床數(shù)據(jù)進(jìn)行高達(dá)20年的追蹤,。所有的患者在接受治療前進(jìn)行過前列腺癌篩查,，而且他們的內(nèi)分泌、生化,、血液學(xué)和尿液圖譜需要接受基線評估,，而且每隔6個(gè)月也要進(jìn)行一次。
在進(jìn)行2966人工年(man-year)治療之后,，研究人員發(fā)現(xiàn)總共確診出14個(gè)新的列腺癌病例(每212年治療后產(chǎn)生一個(gè)病例),。平均確診時(shí)間為6.3年(范圍為1-12年)。進(jìn)行睪酮替換治療對總前列腺特異性抗原(prostate-specific antigen, t-PSA)、游離PSA(free PSA, f-PSA)或者f-PSA與t-PSA的比例并沒有產(chǎn)生統(tǒng)計(jì)學(xué)上顯著性的影響,。研究人員并沒有觀察到任何初始的PSA改變和隨后的前列腺癌確診之間存在聯(lián)系,。
論文作者們在文中寫道，“這項(xiàng)研究提供相當(dāng)多的證據(jù)證實(shí)在采取合適的臨床監(jiān)控下,，睪酮替換療法對前列腺是安全的,，同時(shí)也改善早期的前列腺癌檢測。對個(gè)人而言,，進(jìn)行前列腺定期監(jiān)控的睪酮替換療法可能比任何沒有監(jiān)控的其他療法更加安全,。”(生物谷：Bioon.com)
doi:10.1111/j.1743-6109.2012.02808.x
PMC:
PMID:
Is Testosterone Treatment Good for the Prostate? Study of Safety during Long-Term Treatment
Mark R. Feneley MD, FRCS(Urol)1, Malcolm Carruthers MD
Introduction. For men with androgen deficiency on testosterone replacement therapy (TRT), clinical concern relates to the development of prostate cancer (PCa). Aim. An updated audit of prostate safety from the UK Androgen Study was carried out to analyze the incidence of PCa during long-term TRT. Main Outcome Measures. Diagnosis of PCa in men receiving TRT, by serum prostate-specific antigen (PSA) testing and digital rectal examination (DRE), and its relation to different testosterone preparations. Methods. One thousand three hundred sixty-five men aged 28–87 (mean 55) years with symptomatic androgen deficiency and receiving TRT have been monitored for up to 20 years. All patients were prescreened for PCa by DRE and PSA along with endocrine, biochemical, hematological, and urinary profiles at baseline and every 6 months. Abnormal findings or rising PSA were investigated by transrectal ultrasound and prostate biopsy. The data were compared for the four different testosterone preparations used in TRT, including pellet implants, Restandol, mesterolone, and Testogel. Results. Fourteen new cases of PCa were diagnosed at one case per 212 years treatment, after 2,966 man-years of treatment (one case per 212 years). Time to diagnosis ranged from 1 to 12 years (mean 6.3 years). All tumors were clinically localized and suitable for potentially curative treatment. Initiating testosterone treatment had no statistically significant effect on total PSA, free PSA or free/total PSA ratio, and any initial PSA change had no predictive relationship to subsequent diagnosis of cancer. Conclusions. The incidence of PCa during long-term TRT was equivalent to that expected in the general population. This study adds to the considerable weight of evidence that with proper clinical monitoring, testosterone treatment is safe for the prostate and improves early detection of PCa. Testosterone treatment with regular monitoring of the prostate may be safer for the individual than any alternative without surveillance.
