GnRH激动剂还是拮抗剂？前列腺癌去势治疗的挑战与优化

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GnRH agonist or antagonist？ Challenges and optimizations of medical castration therapy for prostate cancer

XU Tao，ZHANG Weiyu （Department of Urology，Peking University People's Hospital，Beijing l0oo44，China）

ABSTRACT：Androgen deprivation therapy（ADT） is considered the standard treatment for advanced and metastatic prostate cancer.Themostcommonlyused drugs in this therapyaregonadotropin hormone-releasing hormone（GnRH）agonistsand GnRHantagonists.Both types ofdrugs exerttheirtherapeutic efects throughtheendocrine system，buttheir mechanisms of action differ significantly.GnRHagonistsactivate the GnRHreceptor，leading toanegative feedback mechanism，whereas GnRHantagonists directly bind to the GnRHreceptorand block the secretion of folicle-stimulating hormone（FSH）and luteinizing hormone（LH）.These diferences result in varying clinical outcomes.This paper provides asystematiccomparison of thetwo types of drugs in terms of eficacy，safety，adverse events，and improvementsof lowerurinarytractsymptoms （LUTS）in diferent clinical scenarios.Additionally，thepaper also discusss the benefitsof switching between these two treatmentoptionsandthefuture directionsofADT，aiming tooffer practical insights tocliniciansfortheoptimaluseof these therapies.

KEY WORDS：prostate cancer；medicalcastration therapy；androgen deprivation therapy；gonadotropin hormone-releasing hormone agonist；gonadotropin hormone-releasing hormone antagonist；medication adverse events

摘要：前列腺癌去势治疗被认为是目前治疗进展性前列腺癌和转移性前列腺癌的标准治疗方式，最常用的药物是促性腺激素释放激素（GnRH）激动剂和GnRH拮抗剂。（剩余23584字）