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Hormonal interventions and endocrine axis in prostate cancer?
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Five possible pathways to castration resistance?
AR, androgen receptor,DHT, dihydrotestosterone; MAPK, mitogen-activated protein kinase; P, phosphorylated; PSA,prostate-specific antigen; RTK, receptor tyrosine kinase.
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Therapeutic Approaches to Androgen
Deprivation Therapy*
ABLATION OF ANDROGEN SOURCES - Orchiectomy
- ANTIANDROGENS - Cyproterone acetate, Flutamide, Bicalutamide, Nilutamide
- Enzalutamide
- INHIBITION OF LHRH OR LH - Diethylstilbestrol, Leuprolide
- Goserelin, Triptorelin, Histrelin, Cetrorelix, Abarelix, Degarelix
- INHIBITION OF ANDROGEN SYNTHESIS
- Aminoglutethimide, Ketoconazole, Abiraterone
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Dose of Bicalutamide and Leuprolide?
Bicalutamide monotherapy at a 50-mg/day dose was inferior to castration in survival of men with metastatic disease. At a higher dose of 150 mg/day, however, bicalutamide monotherapy appears to have equivalent efficacy to medical or surgical castration.
Inj Leuprolide 3.75mg every three months. *
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as
- Bilateral orchiectomy reduces testosterone by 90% within 24 hours.
- After 4 years of androgen deprivation, the average man is osteopenic.
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