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Sequential hormonal therapy and sequential hormonal and chemotherapy for advanced prostatic cancer
P Ruff1, D P Derman, A Weaving
1Department of Medicine, Hillbrow Hospital, Johannesburg, South Africa.
Oncology
|January 1, 1989
Summary
Diethylstilbestrol (DES) showed a higher initial response rate than orchidectomy for D2 prostate cancer. However, second-line treatments, including medroxyprogesterone acetate (MPA), offered similar palliative benefits without significantly improving survival.
Area of Science:
- Oncology
- Urology
Background:
- Advanced D2 prostate cancer presents treatment challenges.
- Hormonal therapy and chemotherapy are established treatment modalities.
Purpose of the Study:
- To compare the efficacy of diethylstilbestrol (DES) versus orchidectomy as initial treatment for D2 prostate cancer.
- To evaluate the effectiveness of second-line palliative treatments including medroxyprogesterone acetate (MPA), oral chlorambucil, and combination chemotherapy.
Main Methods:
- Ninety-two patients with D2 prostate cancer were studied.
- Initial treatment involved either DES or orchidectomy.
- Fifty-seven patients were randomized to receive second-line treatment with MPA, oral chlorambucil, or combination chemotherapy.
Main Results:
- DES demonstrated a significantly higher initial response rate (81%) compared to orchidectomy (62%; p<0.01).
- No significant difference in response duration or survival was observed between DES and orchidectomy.
- Second-line treatments showed similar overall response rates (46%), primarily disease stabilization with symptomatic benefit, but did not significantly improve survival.
Conclusions:
- For advanced prostate cancer, initial treatment with DES may yield higher response rates than orchidectomy.
- Second-line palliative therapy, particularly MPA, should be the least toxic option, as survival benefits were not significantly improved by more aggressive regimens.