Departments of Urology Clinical Chemistry, VU University Medical Centre, Amsterdam, The Netherlands.
What's known on the subject? and What does the study add? The male steroid hormone metabolism is an important target in the treatment of prostatic diseases. However, present literature is inconsistent about intraprostatic concentrations of steroid hormones and the role of intraprostatic steroid hormones in the arise and the course of prostatic diseases is yet to be determined. Part II of this two-piece mini-review reviews the effect of medication that alters the male steroid hormone metabolism (i.e. 5-alpha reductase inhibitors, androgen deprivation therapy) on intraprostatic steroid hormone concentrations. Better knowledge of the intraprostatic steroid hormone concentrations might lead to more individualized treatment and even to new medical targets. Androgen deprivation therapy (ADT) and 5-α-reductase (5AR) inhibition are used in the treatment of men with advanced or metastatic prostate cancer and benign prostatic hyperplasia (BPH), respectively. These drugs exert their effect by lowering androgen levels in the serum and allegedly, the prostate gland. It is, however, unknown whether (increased) intraprostatic androgen levels are associated with the pathogenesis of BPH and with the initiation and progression of prostate cancer. Also, it is unclear whether intraprostatic dihydrotestosterone (DHT) levels correlate with a response to initial hormonal therapy or with patient outcome. These uncertainties have resulted from the finding that serum testosterone levels do not necessarily reflect those in the prostate gland. Intraprostatic DHT levels of men being treated with 5AR inhibition, of those treated with ADT for hormone-naive prostate cancer, and of those with castration-resistant prostate cancer are all altered in an equivalent manner because of hormonal manipulation. Increased knowledge of the mechanisms of the androgenic steroid pathways in prostatic diseases, with a special focus on intraprostatic androgen levels, may lead to treatment that is tailored to the needs of the individual patient, and probably to new therapeutic targets as well.
Written by:
van der Sluis TM, Meuleman EJ, van Moorselaar RJ, Bui HN, Blankenstein MA, Heijboer AC, Vis AN. Are you the author?
Reference: BJU Int. 2011 Oct 12. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10652.x
PubMed Abstract
PMID: 21992404
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