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Hormonal Therapy of Prostatic Cancer.

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Hormonal therapy for prostate cancer aims to suppress androgens. Early estrogen treatment increased mortality, while delayed therapy showed similar efficacy to early treatment in advanced stages.

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Area of Science:

  • Urology
  • Endocrinology
  • Oncology

Background:

  • Prostate cancer treatment historically focuses on suppressing androgenic stimuli, a principle established by Huggins in 1941.
  • Established treatments for advanced prostate cancer include orchiectomy, estrogen administration, antiandrogen therapy, adrenalectomy, and hypophysectomy.

Purpose of the Study:

  • To review the efficacy and side effects of various hormonal therapies for prostate cancer based on available data, including the VACURG studies.
  • To evaluate the impact of early versus delayed hormonal therapy and compare different treatment modalities like castration and estrogen administration.

Main Methods:

  • Analysis of findings from the Veterans Administration Cooperative Urological Research Group (VACURG) studies.
  • Review of historical and current treatment strategies for advanced prostate cancer, including surgical and pharmacological interventions.

Main Results:

  • Estrogen therapy (diethylstilbestrol) in low-stage prostate cancer was associated with increased cardiovascular mortality compared to no estrogen treatment.
  • In high-stage disease, delayed hormonal therapy demonstrated comparable effectiveness to early hormonal therapy.
  • Castration showed similar efficacy to estrogen treatment without the adverse side effects associated with estrogens.

Conclusions:

  • Castration is a viable alternative to estrogen therapy for advanced prostate cancer due to comparable efficacy and a better side-effect profile.
  • Adrenal or pituitary ablation offers limited long-term benefits and is infrequently used.
  • Further research is needed to predict hormonal responsiveness, potentially through receptor measurements, to guide treatment decisions and consider early chemotherapy for non-responsive cases.