臨床泌尿器科68巻4号

2014年04月発行

増刊号特集 前立腺癌の診療ナビゲーション―わかりやすく丁寧に！ Ⅳ　前立腺癌の治療と問題点 《内分泌療法》

18．CAB療法（併用アンドロゲン遮断療法）の実際と問題点

著者： 神谷直人¹ 鈴木啓悦¹

所属機関： ¹東邦大学医療センター佐倉病院泌尿器科

ページ範囲：P.194 - P.199

036


Q　CAB療法の適応，実際，注意点について教えてください。


Point

●血中アンドロゲン：血液中のアンドロゲンは約95％が精巣由来のテストステロンで，副腎由来のアンドロゲンが約5％。

●前立腺組織中アンドロゲン：前立腺組織中のジヒドロテストステロンの約40％が副腎由来。副腎性アンドロゲンは，前立腺細胞内代謝により変換。

参考文献

1）Huggins C and Hodges CV：Studies on prostatic cancer：Ⅰ. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. J Urol 1：293-297, 1941

2）Suzuki H, Kamiya N, Imamoto T, et al：Current topics and perspectives relating to hormone therapy for prostate cancer. Int J Clin Oncol 13：401-410, 2008

3）並木幹夫：新展開を迎えた前立腺癌治療薬の位置づけCAB and ADEs．泌尿器外科7：1525-1527，2012

4）Labrie F, Dupont A, Belanger A, et al：New hormonal therapy in prostatic carcinoma：combined treatment with an LHRH agonist and an antiandrogen. Clin Invest Med 5：267-275, 1982

5）Klotz L：Combined androgen blockade in prostate cancer：meta-analyses and associated issues. BJU Int 87：806-813, 2001

6）Prostate Cancer Trialists' Collaborative Group：Maximam androgen blockade in advanced prostate cancer：an overview of 22 randomised trials with 3283 deaths in 5710 patients. Lancet 346：265-269, 1995

7）Eisenberger MA, Blumenstein BA, Crawford ED, et al：Bilateral orchiectomy with or without flutamide for metastatic prostate cancer. N Engl J Med 339：1036-1042, 1998

8）Crawford ED, Eisenberger MA, Mcleod DG, et al：A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N Engl J Med 321：419-424, 1989

9）Hinotsu S, Akaza H, Usami M, et al：Current status of endocrine therapy for prostate cancer in Japan analysis of primary androgen deprivation therapy on the basis of data collected by J-CaP. Jpn J Clin Oncol 37：775-781, 2007

10）Akaza H, Hinotsu S, Usami M, et al：Combined androgen blockade with bicalutamide for advanced prostate cancer：long-term follow-up of a phase 3, double-blind, randomized study for survival. Cancer 115：3437-3445, 2009

11）Bolla M, Gonzalez D, Warde P, et al：Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 337：295-300, 1997

12）Cancer Registration Committee of the Japanese Urological Association：Clinicopathological statistics on registered prostate cancer patients in Japan：2000 report from the Japanese Urological Association. Int J Urol 12：46-61, 2005

13）日本泌尿器科学会（編）：前立腺癌診療ガイドライン2012年版，第2版．金原出版，東京，pp178-179，2012

14）NCCN Guidelines：Prostate Cancer, V3. 2012　http://www.tri-kobe.org/nccn/guideline/urological/japanese/prostate.pdf

15）EAU Guidelines on Prostate Cancer, 2013　http://www.uroweb.org/gls/pdf/09_Prostate_Cancer_LR.pdf

16）Suzuki H, Okihara K, Miyake H, et al：Alternative nonsteroidal antiandrogen therapy for advanced prostate cancer that has relapsed after initial maximum androgen blockade. J Urol 180：921-927, 2008

17）Levine GN, D'Amico AV, Berger P, et al：Androgen-deprivation therapy in prostate cancer and cardiovascular risk：a science advisory from the American Heart Association, American Cancer Society, and American Urological Association：endorsed by the American Society for Radiation Oncology Circulation. Circulation 16：833-840, 2010

18）Morote J, Morin JP, Orsola A, et al：Prevalence of osteoporosis during long-term androgen deprivation therapy in patients with prostate cancer. Urology 69：500-504, 2007

19）National Osteoporosis Foundation　http://www.nof.org/articles/10

20）Bayoumi AM, Brown AD and Garber AM：Cost-effectiveness of androgen suppression therapies in advanced prostate cancer. J Natl Cancer Inst 92：1731-1739, 2000

21）Ramsey S, Veenstra D, Clarke L, et al：Is combined androgen blockade with bicalutamide cost-effective compared with combined androgen blockade with flutamide? Urology 66：835-839, 2005

22）Nishimura S, Arai Y, Usami M, et al：Cost-effectiveness analysis of maximum androgen blockade for Japanese men with advanced prostate cancer. Gan To Kagaku Ryoho 34：589-595, 2007