Drugs used 1. One type of drug is depot: luteinizing hormone-releasing hormone analogs (LHRH-A), commonly used are goserelin 3.6 mg, treprostinil 3.75 mg and leuprolide 3.75 mg (trade names Norelide, Inhibiton and Daphylline, respectively). The other type is to block the binding of androgens to receptors: the application of anti-androgen drugs competitively closes the binding of androgens to androgen receptors in prostate cells, commonly used are flutamide and bicalutamide (trade names Fuzeol and Comstock). The combination of the two types of drugs can achieve the maximum androgen blockade. Adverse drug reactions 1. Adverse reactions of depot treatment Depot treatment includes both surgical depot and drug depot. Its common side effects include decreased libido, erectile dysfunction, paroxysmal hot flashes, breast swelling and feminization, personality changes, cognitive decline, as well as decreased bone density and anemia caused by long-term low androgen status. LHRHa is currently the most widely used depot medication. Because of the transient testosterone elevation that occurs at the beginning of the injection, anti-androgen medication needs to be taken two weeks prior to the initial dose. This transient testosterone elevation may lead to exacerbation of clinical symptoms such as bone pain, acute urinary retention, obstructive renal failure, spinal cord compression, and fatal cardiovascular disorders due to hypercoagulable states, which are also characteristic of these drugs. It should be noted that the addition of anti-androgen drugs at the early stage of drug use does not completely eliminate the occurrence of such phenomena. 2.Adverse effects of anti-androgen drugs These drugs do not reduce testosterone, so they have the advantage of having no significant effect on sexual function, and do not produce side effects such as loss of physical fitness and osteoporosis in depot treatment. Breast pain, breast feminization, and paroxysmal hot flashes can occur after taking the drug. Flutamide is administered as 250 mg, one tablet every eight hours. Because it requires conversion to the active drug form hydroxyflutamide in the liver, the drug is hepatotoxic and liver function should be checked regularly while taking the drug. Bicalutamide has a long half-life and can be taken as a single daily dose, so compliance is good. The drug does not need to be metabolized by the liver to have pharmacological activity, so there is no obvious hepatotoxicity. When the adverse reactions are mild, the drug can be closely observed or replaced with other similar drugs. If the reaction is severe, you have to stop the drug and discuss the specific treatment plan with your medical professional. Treatment 1. It is currently the treatment of choice for the treatment and prevention of bone metastases from hormone-non-dependent prostate cancer. Recommended dose: Zolay Phosphate 4 mg IV 15-minute drip every 4 weeks. In order to avoid the damage of drug on kidney function, the intravenous drip time is not less than 15 minutes. 2.Radiotherapy External radiation therapy can improve local and diffuse bone pain. Since patients with prostate cancer have a higher chance of multiple bone metastases, the greater the scope and dose of external radiation therapy, the greater the side effects. Radionuclides have shown efficacy in the treatment of multifocal bone pain due to bone metastases from prostate cancer. 89 strontium and 153 samarium are commonly used radionuclides that significantly reduce new bone metastases, decrease bone pain symptoms, and reduce pain medication dosage. The most common side effect is bone marrow suppression. 3. Analgesic drug therapy The World Health Organization (WHO) has established guidelines for pain management, which also apply to patients with prostate cancer bone metastases. Analgesic treatment must be in accordance with this guideline, regular medication (for pain prevention), stepwise medication: from non-opioids to weak opioids and then to strong opioids, and also appropriate adjuvant therapy (including neuroleptics, radiotherapy, chemotherapy, surgery, etc.).