Publication: Evaluación del impacto de la deprivación androgénica en pacientes diagnosticados de cáncer de próstata en las esferas: psicocognitiva, estado de ánimo, sexual y calidad de vida
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2017-09-21
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Universidad Complutense de Madrid
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Abstract
La testosterona tiene un papel esencial en el crecimiento y la perpetuación de las células tumorales prostáticas. La síntesis del primer análogo de la hormona liberadora de gonadotropina (GnRH), el agonista de la hormona liberadora de la hormona luteinizante [LHRH]), con un papel clave en la regulación de la síntesis de la testosterona, estableció definitivamente la terapia de deprivación androgénica (TDA) en el tratamiento del cáncer de próstata. Los agonistas de la LHRH son capaces de reducir la concentración de testosterona hasta la lograda mediante castración al cabo de 2-4 semanas hasta en un 90% de los pacientes. Se dispone de diversos principios activos con una efectividad similar. Aunque la TDA ha mostrado un claro beneficio en el tratamiento del cáncer de próstata metastásico, también ha demostrado aumentar la supervivencia en pacientes con cáncer de próstata localmente avanzado, estando recomendado su uso por las guías de práctica clínica. Sin embargo, la terapia hormonal, además de incrementar el coste del tratamiento, se asocia a efectos secundarios significativos. Los más frecuentes y conocidos son el efecto deletéreo sobre la función sexual, sobre el metabolismo, la aparición de síntomas vasomotores, de anemia, y la pérdida de densidad mineral ósea. La TDA afecta también a la calidad de vida del paciente, por tratarse de un término que engloba diversos aspectos relacionados con el efecto de la terapia, siendo el componente físico el que se ve mayormente afectado. Otros efectos deletéreos como el deterioro cognitivo, la afectación anímica, los cambios en la composición corporal o sobre la función física (medidos de forma objetiva) no han sido estudiados en profundidad...
Testosterone plays a key role in the growth and perpetuation of prostate tumor cells. The synthesis of the first analogue of the gonadotropin releasing hormone (GnRH), the luteinizing hormone releasing hormone [LHRH]) agonist, which plays a key role in testosterone synthesis regulation, definitively established androgen deprivation therapy (ADT) in the management of prostate cancer. LHRH agonists are capable of reducing the testosterone concentration to that obtained by castration after 2-4 weeks in up to 90% of patients. Several active ingredients with similar effectiveness are now available. Although ADT has shown a clear benefit in the treatment of metastatic prostate cancer, it has also been shown to increase survival in patients with locally advanced prostate cancer and its use is recommended by clinical practice guidelines. However, hormone therapy, besides increasing treatment costs, is associated with significant side effects. The most common and known are the deleterious effects on sexual function and metabolism, the development of vasomotor symptoms, anemia, and loss of bone mineral density. ADT also affects patient quality of life, as it is a term that encompasses various aspects relating to the effect of therapy, with the physical component being the most affected. Other deleterious effects, such as cognitive impairment, mental status impairment, changes in body composition or physical function (measured objectively) have not been studied in depth...
Testosterone plays a key role in the growth and perpetuation of prostate tumor cells. The synthesis of the first analogue of the gonadotropin releasing hormone (GnRH), the luteinizing hormone releasing hormone [LHRH]) agonist, which plays a key role in testosterone synthesis regulation, definitively established androgen deprivation therapy (ADT) in the management of prostate cancer. LHRH agonists are capable of reducing the testosterone concentration to that obtained by castration after 2-4 weeks in up to 90% of patients. Several active ingredients with similar effectiveness are now available. Although ADT has shown a clear benefit in the treatment of metastatic prostate cancer, it has also been shown to increase survival in patients with locally advanced prostate cancer and its use is recommended by clinical practice guidelines. However, hormone therapy, besides increasing treatment costs, is associated with significant side effects. The most common and known are the deleterious effects on sexual function and metabolism, the development of vasomotor symptoms, anemia, and loss of bone mineral density. ADT also affects patient quality of life, as it is a term that encompasses various aspects relating to the effect of therapy, with the physical component being the most affected. Other deleterious effects, such as cognitive impairment, mental status impairment, changes in body composition or physical function (measured objectively) have not been studied in depth...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 28/01/2016