What is the difference between endocrine therapy for prostate cancer and breast cancer? Prostate cancer and some ER and PR positive patients are effective for endocrine therapy, but there are too many differences between the two. 1. The requirements of hormone receptor testing are different. Before deciding on endocrine therapy, patients with prostate cancer do not need to be tested according to androgen receptor expression. As long as the indications are clear, they can directly go on endocrine therapy, which has a therapeutic efficiency of more than 85% to 90%, therefore, endocrine therapy is the main treatment for prostate cancer and can be used throughout the entire course of some prostate cancer patients. Endocrine therapy has an irreplaceable role in other treatments, whether it is advanced, or adjuvant treatment after T3, T2 with high risk factors, N+, or R1 resection. The effective endocrine therapy for breast cancer patients with high expression of ER and PR is more than 60%. Depending on the expression of ER and PR receptors, the effective rate and effective duration are different, just as I said in my lecture, the effect of endocrine therapy for ER receptor expression, 1% positive and 99% positive, is completely different. In other words, endocrine therapy for breast cancer is already very effective, but overall, endocrine therapy for prostate cancer is much more effective. Nowadays, many doctors know about endocrine therapy for breast cancer, but not much about endocrine therapy for prostate cancer. 2. The combined treatment is different. Patients with prostate cancer can combine radiotherapy with endocrine therapy, and the efficacy is not affected; for patients with more than 4 metastatic lesions, endocrine therapy combined with chemotherapy with docetaxel is recommended, and the overall survival is significantly prolonged. While endocrine therapy with triamcinolone acetonide for breast cancer patients cannot be combined with chemotherapy or radiotherapy, including postoperative adjuvant radiotherapy, because triamcinolone acetonide makes tumor cells enter G0 stage and get incognito, which makes chemotherapy and radiotherapy insensitive. (Breast cancer patients treated with endocrine therapy with methotrexate can be combined with radiotherapy or chemotherapy at the same time, the mechanism of action is different). 3. The pointers of depot treatment are different. Adjuvant treatment of prostate cancer, as long as there are indications after surgery or radiotherapy, endocrine therapy is advocated, which has little relationship with age. It is recommended to use drug depot for more than 18 months, and sexual function can be restored after stopping treatment. All advanced prostate cancers, no matter how old they are, need to be treated with debulking, either by drugs or surgery. The age and stage of the disease are related to whether breast cancer should be treated. Postmenopausal breast cancer does not need depot treatment, adjuvant or late stage can be directly used for trimethoprim, while adjuvant endocrine therapy after surgery for young breast cancer, based on triamcinolone, which has estrogen-like effects while antagonizing estrogen, will not cause osteoporosis, while enabling young female patients to maintain normal menstruation and good female psychological and physical characteristics, so that the quality of life does not decline, the latest 2014 The latest evidence-based medical data suggests that triamcinolone acetonide should be used for 10 years, which is long enough to turn some menstruating breast cancer patients into menopausal, so there is no need for depot treatment, and there are endocrine therapy drugs available later. Therefore, for prostate cancer patients, depot treatment is the main part of endocrine therapy, while depot treatment for breast cancer patients is only for young women, advanced stage, and patients with high expression of hormone receptors. 4. The duration of adjuvant therapy is different. Endocrine therapy for prostate cancer only takes more than 18 months, while endocrine therapy for breast cancer takes 5 years, 10 years, or even longer. 5. Similarity: Both are endocrine drugs, that is, hormone drug blocking therapy, whose treatment is effective because of the existence of clear target cells, which is a key to open a lock, and therefore combined with the side effects of the corresponding endocrine system being blocked. 6. Similarity: The mechanism and principle of failure of endocrine therapy for prostate cancer and breast cancer are the same, only that the hair raising is different. The failure of endocrine therapy for breast cancer is called endocrine therapy resistance. The principle of treatment is also the same. As Deng Bo said, endocrine therapy for prostate cancer usually turns out to be …, but it does not mean that all endocrine therapy drugs are ineffective, for example, advanced prostate cancer is usually first treated with double dex, and after a period of resistance, switching to estradiol nitrogen mustard is still effective (the drug should not be classified as a chemotherapy drug, the role is estrogen, not nitrogen mustard hydrochloride, or should be classified as It should still be classified as an endocrine therapy drug), or Abiraterone is still effective. If first-line endocrine therapy for breast cancer fails, it is also resistant to first-line endocrine therapy, and switching to second-line endocrine therapy will still be effective. For example, postmenopausal breast cancer patients who have used triamcinolone first, and after disease progression, use letrozole or anastrozole to remain effective, or use fluviscosetron are second-line endocrine therapy for postmenopausal breast cancer. Whether it is breast cancer or prostate cancer, as long as there is no radical treatment and there are tumor cells remaining in the body, there is a possibility of drug resistance with any drug treatment. Because tumor cells have to adapt to the law of survival of the fittest, there is only one direction to go, and that is the development of drug resistance. This idea stems from the deduction of a mathematical model, which has now been confirmed by clinical trials. True hormone resistance, in breast cancer is the need to re-take the material, send it for pathological examination, do ER and PR tests, and if it was positive and now becomes negative for hormone receptor expression, stop the endocrine therapy and change to chemotherapy, otherwise, as long as the disease is slowly progressing, the principle of endocrine therapy priority should be applied. Of course, chemotherapy is also one of the available treatment methods, and chemotherapy will also weaken the function of the patient’s endocrine system to some extent.