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【科普】前列腺癌术后，如何保护好心脏

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楼主 qiuyuming
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这个帖子发布于10年零255天前，其中的信息可能已发生改变或有所发展。
Ask the doctor: What can I do to protect my heart if my body no longer makes testosterone?
Q. A year ago, I had an orchiectomy for prostate cancer; my PSA is now 0.74. Not long afterward, I had two cardiac stents implanted. I still have some angina and shortness of breath. I started Ranexa a couple of weeks ago, which helps my angina. Do you have any suggestions for my heart since I no longer make testosterone, which I understand helps protect men's hearts and arteries?
A. In men with prostate cancer, testosterone plays opposing roles. On the negative side of the ledger, it fuels the growth of prostate cancer cells, helping them grow, divide, and sometimes spread throughout the body. For this reason, various methods are used to stop the body from making testosterone or to block cells from responding to it. Removing a man's testicles (orchiectomy) is an effective way to shut off production of this hormone without the need for daily medications. Orchiectomy has been used for years to slow or stop the growth and spread of prostate cancer.
On the positive side of the ledger, testosterone helps maintain muscle mass and healthy cardiac function. In men, low levels of testosterone have been linked to an increased risk for developing type 2 diabetes and cardiovascular disease. And several studies suggest that shutting down or blocking testosterone in men with prostate cancer may increase their risk of developing heart disease.
More and more, doctors are prescribing testosterone replacement therapy for relatively healthy men with low testosterone levels (under 300 nanograms per deciliter of blood). But there is no consensus on whether this therapy is safe for men who have had prostate cancer. Some clinicians have prescribed testosterone for men with prostate cancer who meet these three conditions: surgery to remove the prostate (prostatectomy), low-grade cancer confined to the prostate, and a virtually undetectable level of prostate-specific antigen (PSA) in the bloodstream. PSA is a protein produced by prostate and prostate cancer cells, and is used to track the effectiveness of treatment and the possible progression of prostate cancer. But we don't know the long-term effects of testosterone replacement therapy in men with this favorable scenario.
Testosterone replacement is even more controversial for men who were treated with radiation therapy instead of surgery, or in someone like you who has had a bilateral orchiectomy and still has a measurable PSA. This could indicate the presence of viable prostate cells that, under the action of testosterone, may be able to transform into cancer.
Whether or not you make or take testosterone, you can follow a checklist to make sure you are doing everything possible to maintain your heart health. Ranolazine (Ranexa) is a new drug for angina, but don't forget about important older ones: aspirin to make your platelets less sticky, clopidogrel (Plavix) to help keep your stents clear, a beta blocker to reduce your heart's demand for oxygen, and a statin to lower your LDL (bad) cholesterol to 70 milligrams per deciliter or below. In addition, exercise daily, follow a diet that is good for your heart and arteries, maintain a healthy body weight, and don't smoke. With these measures, you're stacking the deck in your favor, testosterone or no testosterone.
— Anthony V. D'Amico, M.D., Ph.D.Professor of Radiation OncologyHarvard Medical SchoolBrigham and Women's Hospital
— Samuel Z. Goldhaber, M.D.Professor of MedicineHarvard Medical SchoolBrigham and Women's Hospital
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2010-06-21 18:40 浏览 : 1500 回复 : 2
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Ask the doctor: What can I do to protect my heart if my body no longer makes testosterone?
Q. A year ago, I had an orchiectomy for prostate cancer; my PSA is now 0.74. Not long afterward, I had two cardiac stents implanted. I still have some angina and shortness of breath. I started Ranexa a couple of weeks ago, which helps my angina. Do you have any suggestions for my heart since I no longer make testosterone, which I understand helps protect men's hearts and arteries?
如果身体不再产生睾丸激素，应该采取什么措施保护心脏呢？
  在一年前,我因患有前列腺癌而行了睾丸切除术;我现在的前列腺特异性抗原是0.74。因我还存在心绞痛和气短等，不久将进行心脏的支架植入术。在几周前我已经开始服用雷诺嗪，其有助于心绞痛的缓解。我认为睾丸激素将有助于男人的心脏、动脉的健康，而对于我来说，应该怎么办呢？您有什么样的建议吗？
A. In men with prostate cancer, testosterone plays opposing roles. On the negative side of the ledger, it fuels the growth of prostate cancer cells, helping them grow, divide, and sometimes spread throughout the body. For this reason, various methods are used to stop the body from making testosterone or to block cells from responding to it. Removing a man's testicles (orchiectomy) is an effective way to shut off production of this hormone without the need for daily medications. Orchiectomy has been used for years to slow or stop the growth and spread of prostate cancer.
On the positive side of the ledger, testosterone helps maintain muscle mass and healthy cardiac function. In men, low levels of testosterone have been linked to an increased risk for developing type 2 diabetes and cardiovascular disease. And several studies suggest that shutting down or blocking testosterone in men with prostate cancer may increase their risk of developing heart disease.
  在前列腺癌患者中，睾丸激素担当着对机体非常不利的角色。睾丸激素能够促进癌细胞的生长、分裂、增长，使其快速的扩散到身体各处。因为这个原因,医生们一般都会通过各种各样的方法，以阻止睾丸产生睾丸激素或阻塞癌症细胞对睾丸激素产生反应。被用来阻止体内睾酮或阻止使细胞反应。将睾丸切除，是一种有效的组织睾丸激素产生的方法，而且还可以避免每天服用药物。睾丸切除术，用来治疗前列腺癌的生长及扩散已经有很多年了。
  睾丸激素，有助于保持肌肉的健康和心功能的正常。在男性，若睾丸激素的水平低的话，则患2型糖尿病和心血管疾病的风险增加。有几项研究表明：因前列腺癌而行睾丸切除术的患者，其患心脏病的风险增加。

More and more, doctors are prescribing testosterone replacement therapy for relatively healthy men with low testosterone levels (under 300 nanograms per deciliter of blood). But there is no consensus on whether this therapy is safe for men who have had prostate cancer. Some clinicians have prescribed testosterone for men with prostate cancer who meet these three conditions: surgery to remove the prostate (prostatectomy), low-grade cancer confined to the prostate, and a virtually undetectable level of prostate-specific antigen (PSA) in the bloodstream. PSA is a protein produced by prostate and prostate cancer cells, and is used to track the effectiveness of treatment and the possible progression of prostate cancer. But we don't know the long-term effects of testosterone replacement therapy in men with this favorable scenario.
  不过现在越来越多的医生，会给相对健康的患者选用睾丸激素替代疗法，使其每1 / 10公升的血液中睾丸激素的低于300毫微克。每的血液)。但对于以前患有前列腺癌的患者来说，是否可以使用这种疗法，目前专家们并没有达成共识。
  使用睾丸激素替代疗法的患者，一般得符合下列三种条件：手术切除前列腺；癌症程度比较低的而且仅限于前列腺内的；血液中前列腺特异抗原(PSA)的含量非常的低，或者是几乎检测不到。前列腺特异抗原(PSA)是前列腺和前列腺癌细胞产生的蛋白质,是用来追踪治疗效果和预测前列腺癌发展趋势的指标。但对于睾丸激素替代疗法的治疗效果，我们并不完全清楚。
Testosterone replacement is even more controversial for men who were treated with radiation therapy instead of surgery, or in someone like you who has had a bilateral orchiectomy and still has a measurable PSA. This could indicate the presence of viable prostate cells that, under the action of testosterone, may be able to transform into cancer.
Whether or not you make or take testosterone, you can follow a checklist to make sure you are doing everything possible to maintain your heart health. Ranolazine (Ranexa) is a new drug for angina, but don't forget about important older ones: aspirin to make your platelets less sticky, clopidogrel (Plavix) to help keep your stents clear, a beta blocker to reduce your heart's demand for oxygen, and a statin to lower your LDL (bad) cholesterol to 70 milligrams per deciliter or below. In addition, exercise daily, follow a diet that is good for your heart and arteries, maintain a healthy body weight, and don't smoke. With these measures, you're stacking the deck in your favor, testosterone or no testosterone.
  睾丸激素替代治疗，甚至比放射疗法替代手术疗法更有争议。在一些患者，就向你一样，即使实施了睾丸切除术，但还是可以测得前列腺特异抗原(PSA)。这可能意味着存在可行的前列腺细胞的作用下,睾丸激素则有助于其,转变成癌。
  您是否应该服用睾丸激素，您可以按照些列清单，来确保心脏的健康。雷诺拉嗪(Ranexa)是一种新的治疗心绞痛的药物治疗,但是不要忘记以前常用的药物:阿斯匹林，用来减少血小板的粘附；氯吡格雷有助于保持支架的清晰；β受体阻断剂可以减少心脏的需氧量；他汀类药物用来降低低密度脂蛋白(坏)胆固醇，并确保其在每分升70毫克或以下。此外,坚持锻炼,坚持健康的饮食，保持健康的体重、不吸烟，这些将有益于心脏和血管。通过这些措施,你也就不会再为睾丸的问题而担忧了。
2010-06-27 20:49
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　 如果身体不再产生睾丸激素，应该采取什么措施保护心脏呢？
  问：在一年前,我因患有前列腺癌而行了睾丸切除术;我现在的前列腺特异性抗原是0.74。因我还存在心绞痛和气短等，不久将进行心脏的支架植入术。在几周前我已经开始服用雷诺嗪，其有助于心绞痛的缓解。我认为睾丸激素将有助于男人的心脏、动脉的健康，而对于我来说，应该怎么办呢？您有什么样的建议吗？
  
  答：在前列腺癌患者中，睾丸激素担当着对机体非常不利的角色。睾丸激素能够促进癌细胞的生长、分裂、增长，使其快速的扩散到身体各处。因为这个原因,医生们一般都会通过各种各样的方法，以阻止睾丸产生睾丸激素或阻塞癌症细胞对睾丸激素产生反应。被用来阻止体内睾酮或阻止使细胞反应。将睾丸切除，是一种有效的组织睾丸激素产生的方法，而且还可以避免每天服用药物。睾丸切除术，用来治疗前列腺癌的生长及扩散已经有很多年了。
  睾丸激素，有助于保持肌肉的健康和心功能的正常。在男性，若睾丸激素的水平低的话，则患2型糖尿病和心血管疾病的风险增加。有几项研究表明：因前列腺癌而行睾丸切除术的患者，其患心脏病的风险增加。
  不过现在越来越多的医生，会给相对健康的患者选用睾丸激素替代疗法，使其每1 / 10公升的血液中睾丸激素的低于300毫微克。每的血液)。但对于以前患有前列腺癌的患者来说，是否可以使用这种疗法，目前专家们并没有达成共识。
  使用睾丸激素替代疗法的患者，一般得符合下列三种条件：手术切除前列腺；癌症程度比较低的而且仅限于前列腺内的；血液中前列腺特异抗原(PSA)的含量非常的低，或者是几乎检测不到。前列腺特异抗原(PSA)是前列腺和前列腺癌细胞产生的蛋白质,是用来追踪治疗效果和预测前列腺癌发展趋势的指标。但对于睾丸激素替代疗法的治疗效果，我们并不完全清楚。
  睾丸激素替代治疗，甚至比放射疗法替代手术疗法更有争议。在一些患者，就向你一样，即使实施了睾丸切除术，但还是可以测得前列腺特异抗原(PSA)。这可能意味着存在可行的前列腺细胞的作用下,睾丸激素则有助于其,转变成癌。
  您是否应该服用睾丸激素，您可以按照些列清单，来确保心脏的健康。雷诺拉嗪(Ranexa)是一种新的治疗心绞痛的药物治疗,但是不要忘记以前常用的药物:阿斯匹林，用来减少血小板的粘附；氯吡格雷有助于保持支架的清晰；β受体阻断剂可以减少心脏的需氧量；他汀类药物用来降低低密度脂蛋白(坏)胆固醇，并确保其在每分升70毫克或以下。此外,坚持锻炼,坚持健康的饮食，保持健康的体重、不吸烟，这些将有益于心脏和血管。通过这些措施,你也就不会再为睾丸的问题而担忧了。
2010-06-27 20:51
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