Androgen-targeted therapy in men with prostate cancer
Mahdokht Forouzan moheb,
1,* Mohammad hasan karimi,
2 Hamidreza raeesour,
3 Faranak jamshidian,
4 Nafise taromi,
5 Sonia daraei,
6
1. department of biology, faculty of basic sciences, north tehran branch, islamic azad university, tehran, iran
2. department of biology, faculty of basic sciences, tonekabon branch, islamic azad university, mazandaran, iran
3. department of biology, varamin pishva branch islamic azad university, varamin pishva iran
4. department of biology, faculty of basic sciences, east tehran branch (ghiamdasht), islamic azad university, tehran, iran
5. iran university of medical sience
6. microbial biotechnology semnan university
Abstract
Introduction
Prostate cancer is the second most common cancer and is the leading cause of death in men. androgen deprivation therapy (adt), specifically surgical or medical castration, is the first line of treatment against advanced prostate cancer and is also used as an adjuvant to local treatment of high-risk disease. androgen deprivation therapy (adt) is foundational in the management of advanced prostate cancer (pca) and has benefitted from a recent explosion in scientific advances. these include approval of new therapies that suppress testosterone (t) levels or inactivate its function, improvements in diagnostic and assay technologies, identification of lower therapeutic targets for t, discovery of the relevance of germline genetic mutations and identification of the benefits of sequential and combination therapies.
Methods
This review discusses the clinical profiles of the most up-to-date options for adt, best practices for managing patients with advanced pca and future directions in therapy.
1.we performed a search in pubmed with the following mesh terms: androgen, prostate cancer, prostate specific antigen, personal medicine
2.the search was narrowed to original articles published in english.
Results
Modern test techniques indicate that bilateral evaluation at a serum t level of about 15 ng / dl compared to the costa riche definition of t <50 ng / dl. evidence suggests that reducing t levels to <20 ng / dl increases patient longevity and delayed disease progression. regular monitoring of t for certain prostatic antigens during treatment is important to ensure the continued effectiveness of t-uptake. new drugs that prevent the production of androgen signals in combination with traditional adts have weakened near-zero activity and improved patient survival and improve (quality of life) qol. when personalizing adt regimens physicians should consider a number of factors including initiation and duration of adt, monitoring of t levels and psa, the possibility of switching monotherapies if a patient does not achieve adequate t suppression, and consideration of intermittent vs. continuous adt according to patients’ lifestyles, comorbidities, risk factors and tolerance to treatment.
Conclusion
The management of advanced pca has undergone a revolution science and data in androgen-targeted therapies drugs, in combination with adt, dramatically inhibit the availability of t to the tumor by near complete inhibition of the androgen signaling pathway. additional studies on the benefit of these and other androgen pathway inhibitors in all stages of advanced pca will likely produce similar results and confirm the importance of suppression of t to <20 ng/dl. monitoring of t is essential to ensure success in achievement of this target. as monotherapy, very low levels of t including nadirs less than 5 mg/dl are achieved by some drugs. new products in development are employing novelmechanisms with greater potency or selectivity, orenhanced delivery to further improve on current therapies.
Keywords
Androgen, prostate cancer, prostate specific antigen, personal medicine.
