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SUPRESION ANDROGENICA INTERMITENTE ESTADO ACTUAL Y PERSPECTIVAS

SUPRESION ANDROGENICA INTERMITENTE ESTADO ACTUAL Y PERSPECTIVAS. Juan Morote Robles Servicio de Urología y Trasplante Renal. BASIS FOR THE HYPOTHESIS OF INTTERMITTENT ANDROGEN SUPRESSION . A reduction higher than 80% intracelular DHT induce apoptosis.

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SUPRESION ANDROGENICA INTERMITENTE ESTADO ACTUAL Y PERSPECTIVAS

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  1. SUPRESION ANDROGENICA INTERMITENTE ESTADO ACTUAL Y PERSPECTIVAS Juan Morote Robles Servicio de Urología y Trasplante Renal

  2. BASIS FOR THE HYPOTHESIS OF INTTERMITTENT ANDROGEN SUPRESSION • A reduction higher than 80% intracelular DHT induce apoptosis. Kyprinaou N and Isaacs JT. Prostate 11: 41-50, 1987. • Androgenindependentprogression (AIP) beginwhenstemcells changeitsphenotipe. Bruchousky N et al. Cancer Res 50: 2275-82, 1990.

  3. EFFECTS OF INTERMITTENT ANDROGEN WITHDRAWAL ON SERUM TESTOSTERONE AND PSA Conclusions: Intermittent androgen suppression can be used to induce multiple apoptotic regressions of a tumor; they also suggest that the cyclic effects of such treatment on prostate cancer can be followed by the sequential measurement of serum PSA levels.

  4. THE CHALLENGES FOR INTERMITTENT ANDROGEN DEPRIVATION • REDUCE Secondary effects of CAD • INCREASE Quality of live • REDUCECost of treatment • MAINTAINSurvival free of AIP

  5. SERUM PSA AND TESTOSTERONE BEHAVIOR DURING IAD Sadar et al, Endocr Relat Cancer 6:487-502, 1999

  6. PROSTATE CANCER TREATMENT GUIDELINES Support to IAD American Urological Association No European Association of Urology Yes American Society of Clinical Oncology No National Institute for Heath and Cinical Excellence Yes Irrespective of official guideline recommendations, IAD is worldwide used by urologist and oncologist

  7. Data from 19 phase 2 studies. Interim data from 8 phase 3 trials

  8. CONCLUSIONS • Duration of biochemical remission after a period of HT is an early indicator of how • rapidly AIPC and death will occur. • Initial PSA level and PSA nadir allow the identification of patients with prostate • cancer in whom it might be possible to avoid radical therapy. • Patients spent a mean of 39% of the time off treatment..

  9. ANALISIS DEL NUMERO DE CICLOS Y TIEMPO SIN TRATAMIENTO

  10. Sexual activity in patients receiving IAD compared with CAD Calais da Silva trial

  11. Which side effects can be prevented or treated Adapted of HiganoCS. Urology 2003; 61:32-8.

  12. Metabolicsyndrome in menunder ADT Cardiovascular mortality

  13. PREVALENCE OF METABOLIC SYNDROME IN MEN UNDER ADT A case-control study (ATP III panel criteria) p < 0.02 P > 0.05 Prevalence RR of MS under ADT: 1.83 Ropero et al. EAU 2010

  14. REFLEXIONES SOBRE LA SUPRESION ANDROGENICA INTERMITENTE • Existealgunacontraindicacióninicial de IAD? • Qué nadir de PSA esprecisoalcanzarpararetirar la SA? • Qué PSA esprecisoalcanzarparareiniciar un nuevociclo? • Cándodejar la AID contínua? • Utilizarantiandrógeno en cadaciclo? • Quéformulación de análogoutilizar? • Cuáles la oportunidad de la AID con antiandrógenos? • Papel de los antagonistas en la AID?

  15. CONCLUSIONES SOBRE LA SUPRESION ANDROGENICA INTERMITENTE • Es unaalternativa de tratamientocoherenteporque: • No es inferior a la CAD • Menortasa de efectossecundarios • Másbarata • Mayor calidad de vida • Requiere mayor control • Las guíasdeberíanreconocerlacomoalternativa de SA

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