促黄体激素释放激素激动剂(LHRH-A),戈舍瑞林,和拮抗剂,地加里克斯,两者都适用于晚期前列腺癌(PCa)的治疗;然而,缺乏评估其疗效和安全性的大型比较试验.在这次审查中,我们评估了两种药物的现有证据.尽管地加瑞克在睾酮(T)和前列腺特异性抗原(PSA)水平方面实现了早期快速下降,中位数T和PSA水平,除了前列腺体积和国际前列腺症状评分,在剩余的治疗期间变得与戈舍瑞林相当。Degarelix没有引起初始耀斑,因此,建议在脊柱转移或输尿管梗阻患者中使用。戈舍瑞林实现了较低的PSA,改进的进步时间,和更好的生存结果时,辅助放疗与单纯放疗相比,即使在长期随访中也有显著的结果。支持使用degarelix佐剂的证据有限。戈舍瑞林具有更好的注射部位安全性,单步交付,与地加里克斯相比,有效的给药方案,具有明显较高的注射部位反应和较低的有效给药机制。关于心血管疾病(CVD)风险的证据相互矛盾,在先前存在的CVD患者中使用LHRH-A时需要谨慎。有相当多的长期证据表明戈舍瑞林在晚期PCa患者中,Degarelix是最近的选择。戈舍瑞林与地加瑞克的现有比较证据有几个与研究设计相关的固有局限性。样本量,行为,和统计分析,因此需要进行稳健的前瞻性试验和长期随访.
Luteinizing hormone-releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this
review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.